Unraveling the Mystery: Medications That Cause Weight Gain

Medications and Weight Gain: What You Need to Know

Have you ever diligently followed your doctor's prescriptions, only to find your waistline expanding despite your efforts to maintain a healthy lifestyle? Weight gain can be a frustrating and perplexing side effect of certain medications, and what's even more frustrating is that some people may unknowingly be taking these medications. In this article, we’ll explore the most common medications that cause weight gain, as well as better alternatives, and how to discuss whether it’s safe to change the medications with your providers.

Antidepressants:

Examples: Selective serotonin reuptake inhibitors (SSRIs) like paroxetine and citalopram, tricyclic antidepressants (TCAs) such as amitriptyline, and mirtazapine.

How they cause weight gain: Antidepressants can affect neurotransmitter levels in the brain, leading to changes in appetite, metabolism, and energy balance. SSRIs, TCAs, and mirtazapine have been associated with weight gain ranging from 5 to 15 pounds on average (1).

Alternatives: Bupropion is an effective antidepressant that has actually been associated with weight loss in some individuals. Some SSRIs, like sertraline and fluoxetine, may have a lower risk of weight gain. Additionally, newer antidepressants like vilazodone and vortioxetine may be considered as alternatives.

Sedating Antihistamines:

Examples: Diphenhydramine, hydroxyzine.

How they cause weight gain: Older, first-generation antihistamines can cause sedation and increase appetite, contributing to weight gain. Weight gain with antihistamines is typically minimal, ranging from 1 to 5 pounds on average (2).

Alternatives: Second-generation antihistamines like cetirizine and loratadine are less likely to cause weight gain. For people taking antihistamines for sleep, we typically recommend melatonin as a better option.

Beta Blockers:

Examples: Metoprolol, propranolol, and atenolol (typically used for high blood pressure and heart disease)

How they cause weight gain: Beta blockers can decrease metabolism and promote fluid retention, leading to weight gain over time. Weight gain with beta blockers can vary, with some individuals experiencing minimal weight gain and others gaining more substantial amounts.

Alternatives: Alternative medications for managing conditions like hypertension or heart disease may be considered, such as carvedilol and other blood pressure medications,, depending on individual health needs.

Insulin, Sulfonylureas, and Thiazolidinediones:

Examples: Insulin, glyburide, glipizide, and pioglitazone

How they cause weight gain: Insulin and certain oral diabetic medications, such as sulfonylureas, can lower blood sugar levels and increase appetite, leading to weight gain over time. Weight gain with these medications can vary depending on individual factors such as insulin dosage and dietary habits.

Alternatives: Many of our patients lose weight when being switched to GLP-1 medications like Mounjaro and Ozempic, while optimizing control of their A1C. In fact, the latest guidelines from the American College of Physicians recommends GLP-1 medications (as well as SGLT2 inhibitors like Jardiance) over insulin for type 2 diabetics, and they have the important benefit of weight loss (4). Metformin is another safe and effective diabetic medication that is associated with some weight loss. 

Steroids:

Examples: Prednisone, hydrocortisone.

How they cause weight gain: Steroids can increase appetite, alter metabolism, and promote fluid retention, leading to significant weight gain. Weight gain with steroids can range from 5 to 20 pounds or more, depending on the duration and dosage of treatment.

Alternatives: In some cases, alternative treatment options or lower doses of steroids may help minimize weight gain while still managing the underlying condition.

Antipsychotics:

Examples: Olanzapine, clozapine, and risperidone.

How they cause weight gain: Antipsychotic medications can stimulate appetite and alter metabolic function, contributing to weight gain. Weight gain with antipsychotics can vary widely, with some individuals gaining as little as 5 pounds and others gaining 20 pounds or more (3).

Alternatives: Ideally, it would be best if the medications can be safely weaned off. However, second-generation antipsychotics like aripiprazole and ziprasidone may have a lower propensity for weight gain compared to first-generation antipsychotics.

Mood Stabilizers:

Examples: Lithium, valproate.

How they cause weight gain: Mood stabilizers can affect appetite, metabolism, and fluid retention, leading to weight gain. Weight gain with mood stabilizers can range from 5 to 20 pounds or more.

Alternatives: Some anticonvulsants, such as topiramate, may be considered as alternatives for mood stabilization with a lower risk of weight gain.

Navigating the Discussion: Addressing Medication-Induced Weight Gain with Your Healthcare Provider

It's essential to approach the topic of medication-induced weight gain with your healthcare provider in a constructive and informed manner. Here's how to navigate the conversation:

• Open Communication: Initiate an open and honest discussion with your healthcare provider about your concerns regarding medication-induced weight gain. Share any changes in your weight or any other side effects you may be experiencing.
• Exploring Alternatives: Work with your healthcare provider to explore alternative medications within the same therapeutic class or consider adjunct therapies that may help mitigate weight gain.
• Balancing Risks and Benefits: Recognize that in some cases, the benefits of medication therapy may outweigh the risks of weight gain. Your healthcare provider can help assess the overall risk-benefit profile and determine the most appropriate course of action.
• Individualized Approach: Understand that responses to medications vary among individuals. Your healthcare provider can tailor treatment options to meet your specific needs and preferences.
• Gradual Changes: If medication adjustments are deemed necessary, they should be made gradually and under the guidance of your healthcare provider to minimize potential withdrawal effects and ensure continued effectiveness of treatment.

Conclusion: Empowering You on Your Health Journey

In conclusion, while medication-induced weight gain can be challenging to navigate, it's essential to approach the topic with informed discussions and collaborative decision-making with your healthcare provider. By working together, you can explore strategies to manage weight gain effectively while optimizing your overall health and well-being. Remember, never make changes to your medication regimen without consulting your healthcare provider first, as they can provide valuable guidance and support throughout the process.

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References:

1. Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010 Oct;71(10):1259-72. doi: 10.4088/JCP.09r05346blu. PMID: 21062615.
2. Ratliff JC, Barber JA, Palmese LB, Reutenauer EL, Tek C. Association of prescription H1 antihistamine use with obesity: results from the National Health and Nutrition Examination Survey. Obesity (Silver Spring). 2010 Dec;18(12):2398-400. doi: 10.1038/oby.2010.176. Epub 2010 Aug 12. PMID: 20706200; PMCID: PMC3221329.
3. Dayabandara M, Hanwella R, Ratnatunga S, Seneviratne S, Suraweera C, de Silva VA. Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatr Dis Treat. 2017 Aug 22;13:2231-2241. doi: 10.2147/NDT.S113099. PMID: 28883731; PMCID: PMC5574691.
4. Qaseem A, Obley AJ, Shamliyan T, Hicks LA, Harrod CS, Crandall CJ; Clinical Guidelines Committee of the American College of Physicians; Balk EM, Cooney TG, Cross JT Jr, Fitterman N, Lin JS, Maroto M, Miller MC, Shekelle P, Tice JA, Tufte JE, Etxeandia-Ikobaltzeta I, Yost J. Newer Pharmacologic Treatments in Adults With Type 2 Diabetes: A Clinical Guideline From the American College of Physicians. Ann Intern Med. 2024 May;177(5):658-666. doi: 10.7326/M23-2788. Epub 2024 Apr 19. PMID: 38639546.

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