General Hospital Psychiatry 37 (2015) 46–48

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General Hospital Psychiatry

journal homepage: http://www.ghpjournal.com

Weight gain and associated factors in patients using newer

antidepressant drugs☆
Faruk Uguz, M.D. a,⁎, Mine Sahingoz, M.D. a, Buket Gungor, M.D. b, Fadime Aksoy, M.D. a, Rustem Askin, M.D. b
a
Department of Psychiatry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey
b
Department of Psychiatry, Sevket Yilmaz Research and Training Hospital, Bursa, Turkey

a r t i c l e i n f o a b s t r a c t

Article history: Objective: The aim of the present study was to examine weight gain and its association with clinical and
Received 11 April 2014 sociodemographic characteristics in patients using newer antidepressants.
Revised 25 October 2014 Methods: The study had a cross-sectional design. A total of 362 consecutive psychiatric patients taking antide-
Accepted 27 October 2014 pressant drugs for 6 to 36 months were included in the study.
Results: The prevalence rate of weight gain was 55.2%; 40.6% of the patients had a weight gain of 7% or more
Keywords:
compared to the baseline. Overall, antidepressant use was significantly related to increased body weight. Specifi-
Antidepressants
Weight gain
cally, citalopram, escitalopram, sertraline, paroxetine, venlafaxine, duloxetine and mirtazapine, but not fluoxetine,
Body mass index were associated with significant weight gain. Multivariate logistic regression analysis indicated that lower educa-
tion status, lower body mass index at the onset of antidepressant use and family history of obesity were indepen-
dent predictors of weight gain ≥7% compared to the baseline.
Conclusions: The study results suggest that patients who take newer antidepressants might have significant
problems related to body weight.
© 2015 Elsevier Inc. All rights reserved.

1. Introduction
Weight gain is an important problem that contributes to patient
noncompliance and can lead to medical comorbidity [1]. In the last two
decades, there has been growing interest in the topic of psychotropic
medications and body weight. The relationship between new-
generation antipsychotics and weight gain has been well documented.
However, compared with antipsychotics, interest in the effects of antide-
pressant drugs, which are frequently used in the treatment of depression
or anxiety disorders, on body weight is more limited in the literature.
The study data on the effects of antidepressants are based mostly on
clinical trials examining their efficacy and safety in the treatment of
psychiatric disorders. Previously, some authors have reported that, in
contrast to tricyclic antidepressants, selective serotonin reuptake inhibi-
tors (SSRIs) were thought to induce weight loss rather than weight gain
[2]. A meta-analysis including clinical trials prior to 2009 suggested that
amitriptyline and mirtazapine were associated with significant increase
in rate of weight gain in both acute and maintenance periods of the treat-
ment. In contrast, none of the SSRIs, venlafaxine and duloxetine were
related to weight gain in the acute phase of treatment. Only two agents
☆ Conflicts of interest and source of funding: The authors have no conflict of interest
with any commercial or other associations in connection with the submitted paper. In
addition, they have no source of funding.
⁎ Corresponding author. Tel.: +90 332 223 6306.
E-mail addresses: farukuguz@gmail.com (F. Uguz), drpekalkan@hotmail.com
(M. Sahingoz), buket.gungor@yahoo.com (B. Gungor), fadime_aksoy84@hotmail.com
(F. Aksoy), rustemaskin@gmail.com (R. Askin).
among the SSRIs, paroxetine and citalopram, were found to be associated
with weight gain during medium- and long-term treatment [3]. Similarly,
Dent et al. [4] reported that mirtazapine, paroxetine, amitriptyline,
citalopram and escitalopram were associated with weight gain. However,
most of the available studies do not include data such as the rate of weight
gain and factors related to weight gain in patients taking antidepressants.
Thus, the aim of the present study was to examine weight changes, the
rate of significant weight gain and factors associated with significant
weight gain in these patients.
2. Methods
The current study was conducted among patients who were admitted
to the outpatient clinics of three hospitals. The sample included 362
consecutive patients who met the criteria of the present study. The inclu-
sion criteria were (a) age18–65 years, (b) willingness to participate in the
study, (c) use of antidepressant drugs for 6–36 months and (d) ability to
definitively follow and describe weight changes from initiation of the
antidepressant treatment to the assessment. The exclusion criteria for
the study were (a) mental retardation; (b) history of schizophrenia or
related psychotic disorders or bipolar disorders; (c) concomitant medical
illnesses such as cardiopulmonary disease, neurological disease, metabolic
disturbances, hematological or other carsinomas, endocrine abnormali-
ties and inflammatory bowel diseases; (d) history of any acute medical
disease, such as an infectious disease, during the previous month;
(e) use of any medical drugs that could lead to weight gain or weight
loss, such as corticosteroids, oral contraceptives, antihistamines and

http://dx.doi.org/10.1016/j.genhosppsych.2014.10.011
0163-8343/© 2015 Elsevier Inc. All rights reserved.
 F. Uguz et al. / General Hospital Psychiatry 37 (2015) 46–48 47

antiepileptic drugs; (f) weight loss due to psychiatric disorders before Table 2
starting the antidepressant treatment; (g) use of any other psychotropic Sociodemographic and clinical features in patients with and without significant (7% or more)
weight gain
drugs at the same time as the antidepressant drug; (h) combined anti-
depressant usage and (i) any confusing reports by the patients about Patients with Patients without P value
their weight changes during the treatment. weight gain weight gain
n=147 n=215
Initially, the objectives and procedures of the study were explained to
all participants, and written informed consent forms were obtained. In ad- Age, mean±S.D., years 38.53±10.29 41.82±12.71 .009a
Education, mean±S.D., years 9.72±2.57 10.48±2.82 .007b
dition, the local Ethics Committee approved the study. A semistructured
Number of children, mean±S.D. 1.94±1.15 1.99±1.22 .698a
interview form developed by the investigators was used to determine Weight at baseline, mean±S.D., kg 64.03±11.97 70.78±12.74 .000a
sociodemographic features and use of antidepressant drugs. After the BMI at baseline, mean±S.D. 23.76±4.24 26.01±4.46 .000a
sociodemographic characteristics were obtained, information regarding Duration of antidepressant, 14.86±10.05 13.36±8.46 .259b
each patient’s weight before and after the antidepressant treatment was mean±S.D., months
Gender, n (%) .004c
recorded. Study data on the weight change, history of medical illnesses,
Female 127 (86.4) 158 (73.5)
use of medical drugs and family history of obesity and diabetes were Employment status, n (%) .908c
based on the patients’ reports. Unemployed 103 (70.1) 149 (69.3)
All statistical analyses were performed using SPSS (Statistical Package Family income level, n (%) .127d
Low (b$10,000/year) 27 (18.4) 34 (15.8)
for the Social Sciences), version 16.0, for Windows. Differences with
Moderate ($10,000–30,000/year) 103 (70.1) 139 (64.7)
regard to continuous variables, 3 or more×2 categorical variables and High (N$30,000/year) 17 (11.6) 42 (19.5)
2×2 categorical variables between the groups were analyzed with Marital status, n (%) .394c
t test, χ 2 test and Fisher’s Exact Test, respectively. The correlations be- Single 19 (12.9) 30 (14.0)
tween final weight and the dose and duration of each antidepressant Married 123 (83.7) 171 (79.5)
Widowed, divorced or separated 5 (3.4) 14 (6.5)
were analyzed with Pearson correlation test. To determine independent
Smoking, n (%) 31 (21.1) 51 (23.7) .610c
factors associated with weight gain, multivariate binary logistic regres- Family history of diabetes, n (%) 50 (34.0) 63 (29.3) .357c
sion analysis was used. All significant levels were two-tailed and set at Family history of obesity, n (%) 47 (32.0) 42 (19.5) .009c
the level of .05. a
t test.
b
Mann–Whitney U test.
c
3. Results Fisher’s Exact Test.
d
χ2 test.

The mean age of the sample (n=362) was 40.49±11.89 years.

Most subjects were women (n= 285, 78.7%), were married (n=294,
81.2%), were unemployed (n=252, 69.6%) and had moderate economi-
cal level (n=242, 66.9%). The mean duration of education was 10.17±
2.74 years. The proportion of patients who smoke was 22.7%. Of
the participants, 89 (24.6%) had a family history of obesity, and 113
(31.2%) had a family history of diabetes mellitus. The most commonly
used antidepressants were sertraline (n= 80, 22.1%) and paroxetine
(n= 80, 22.1%) followed by escitalopram (n= 76, 21.0%), venlafaxine
(n= 49, 13.5%), fluoxetine (n= 29, 8.0%), citalopram (n= 19, 5.3%),
mirtazapine (n=17, 4.7%) and duloxetine (n=12, 3.3%).
The results indicated that body weight increased with antidepressant
use in 55.2% of the patients (n=200), weight remained unchanged
in 40.5% (n=147) and a decrease in weight was observed in 4.1%
(n=15). Of the 200 patients, 177 (48.8%) described an increase in appe-
tite, and 143 (39.5%) reported a craving for carbohydrates. The mean
weight gain was 4.97±6.16 kg, and the mean onset time of weight gain
following the administration of antidepressants was 2.28±1.99 months.
Weight gain was observed in 85.0% of the patients, with body weight
increasing within the first 3 months following the initiation of antide-
pressant use.
The mean body weight before and after the treatment was
68.04±12.86 kg and 72.76±12.71 kg, respectively; the difference was
statistically significant (P=.000). Of 362 patients, 147 (40.6%) showed
a weight gain of 7% or more compared to the baseline weight, and
7.2% showed a weight gain of 20% or more. Table 1 presents the specific
antidepressants and the variables related to body weight. Citalopram,
escitalopram, sertraline, paroxetine, venlafaxine, duloxetine and
mirtazapine, but not fluoxetine, were associated with significant weight
gain. Patients receiving mirtazapine (76.5%), paroxetine (55.0%),
venlafaxine (52.1%) and escitalopram (48.7%) gained 7% or more
compared with the baseline weight. These proportions were 33.3%,
31.6%, 20.0% and 6.9 % in patients taking duloxetine, citalopram, sertraline
and fluoxetine, respectively. In addition, patients receiving mirtazapine
(17.6%), venlafaxine (12.5%), citalopram (10.5%) and paroxetine (10.0%)
reported a weight gain of 20% or more.
Statistical analysis indicated no significant differences in marital
status, employment status, economical level, smoking, family history of
diabetes, number of children or duration of antidepressant treatment be-
tween subjects with and without weight gain following the treatment.
The subjects who gained weight were primarily female and younger,
with a family history of obesity, fewer years of education and lower
body weight and body mass index (BMI) at the onset of antidepressant
therapy (Table 2). We found no significant correlation between final
weight and the dose and duration of each antidepressant (Table 3).
Multivariate logistic regression analysis indicated that fewer years
of education [Wald χ 2= 12.23, S.E: 0.049, odds ratio (OR): 0.842,
P=.000], lower BMI at the onset of the antidepressant therapy (Wald
χ2=4.59, S.E: 0.062, OR: 0.876, P=.032) and a family history of obesity

Table 1
Weight changes following specific antidepressant treatment in the patients

Drug Weight at baseline Weight after treatment P value Patients with weight Weight gain of 7% Weight gain of 20%
gain, n (%) or more, n (%) or more, n (%)

Citalopram, n=19 69.26±13.34 74.78±9.92 .014 10 (52.6) 6 (31.6) 2 (10.5)

Fluoxetine, n=29 71.24±13.98 71.10±12.43 .893 4 (13.8) 2 (6.9) 0 (0)
Escitalopram, n=76 68.14±12.49 73.96±12.51 .000 49 (64.5) 37 (48.7) 7 (9.2)
Paroxetine, n=80 67.12±12.46 73.13±12.88 .000 59 (73.8) 44 (55.0) 8 (10.0)
Sertraline, n=80 69.75±12.87 72.01±12.82 .000 27 (33.8) 16 (20.0) 1 (1.2)
Venlafaxine, n=49 66.62±11.60 74.06±13.45 .000 31 (64.6) 25 (52.1) 6 (12.5)
Mirtazapine, n=17 56.88±11.96 67.29±9.51 .001 15 (88.2) 13 (76.5) 3 (17.6)
Duloxetine, n=12 73.83±13.14 76.75±13.55 .038 5 (41.7) 4 (33.3) 0 (0)
48 F. Uguz et al. / General Hospital Psychiatry 37 (2015) 46–48

Table 3
The mean dose and duration of each antidepressant and their correlations with final weight

Drug The mean dose, mg Correlations The mean duration, month Correlations
The final weight and dose The final weight and duration

r P r P

Citalopram, n=19 25.57±5.01 −0.205 .405 14.89±9.15 −0.031 .902

Fluoxetine, n=29 23.96±8.38 0.229 .232 12.20±873 −0.049 .801
Escitalopram, n=76 16.86±5.51 0.112 .336 12.75±8.55 0.158 .172
Paroxetine, n=80 23.43±7.77 0.116 .306 14.57±8.96 0.176 .119
Sertraline, n=80 81.56±39.12 0.011 .921 13.03±8.56 0.118 .298
Venlafaxine, n=49 126,56±49.30 0.176 .233 17.93±10.76 0.144 .328
Mirtazapine, n=17 29.11±11.21 −0.209 .422 13.47±9.74 0.200 .441
Duloxetine, n=12 57.50±8.66 −0.029 .939 12.08±7.60 −0.498 .105

(Wald χ2=12.33, S.E: 0.278, OR: 2.657, P=.000), but not gender (Wald
χ 2= 0.22, S.E: 0.384, OR: 0.833, P= .634), age (Wald χ 2= 0.59, S.E:
0.011, OR: 0.992, P=.442) or body weight at the onset of the antidepres-
sant treatment (Wald χ2=0.21, S.E: 0.023, OR: 0.646, P=.990), were in-
dependent predictors of weight gain following usage of antidepressants.
4. Discussion
This descriptive cross-sectional study suggests that sertraline,
paroxetine, citalopram, escitalopram, mirtazapine, venlafaxine and
duloxetine are associated with significant weight gain. In contrast, it
appears that fluoxetine does not have any effect on body weight. There
are some differences between the results of the current study and
those of some previously published studies. Serretti et al. [3] reported
that paroxetine and mirtazapine, but not the other newer antidepres-
sants, were associated with a greater risk of weight gain. They also
reported that the mean weight difference during long-term treatment
was 2.73 kg for paroxetine and 2.59 kg for mirtazapine. According to a
systematic review [4], venlafaxine, fluoxetine and sertraline have
minimal effects on weight gain. An analysis of 10 clinical studies by
Wise et al. [5] indicated that long-term use of duloxetine (mean weight
gain: 0.9 kg) and paroxetine (mean weight gain: 1.0 kg) was significantly
associated with weight gain. The mean weight increase was higher in our
sample than in these previous studies. However, the results of several
other studies are relatively consistent with ours. Patten et al. [6] reported
that the mean body weight increased from 72.9 to 76.9 kg after 12 years.
Dannon et al. [7] noted that patients using paroxetine experienced an
average weight gain of 5.06 kg. Similarly, another naturalistic study
suggested that mean increase in body weight was significant at 6.1 kg;
that study reported mean weight gains of 5.2, 6.9, 8.2 and 6.3 kg with flu-
oxetine, citalopram, paroxetine and fluvoxamine, respectively [8].
Data regarding the prevalence rate of weight gain following the use of
antidepressants are limited. In the present study, it was found that most
of the patients receiving mirtazapine; approximately half of the patients
taking escitalopram, paroxetine and venlafaxine; and approximately one
thirds of the patients using citalopram and duloxetine reported an
increase of at least 7% of the baseline weight. Wise et al. [5] reported
that the prevalence rate of weight gain was 12.8% for duloxetine and
13.8% for paroxetine, and Bet et al. [9] reported that the prevalence
rates in patients using SSRIs, venlafaxine and mirtazapine were 19%,
17% and 29%, respectively. The discrepancies among study results
might be due to differences in study design and sample characteristics.
To date, very few studies have examined the factors associated
with weight gain in patients undergoing antidepressant treatment. A
naturalistic study suggested that the female gender and a longer
duration of antidepressant use were risk factors for weight gain [9]. A
longitudinal study carried out in Canada [6] reported that weight gain
was related to a lower BMI at baseline, the male gender and age under
65 years. In our study, lower BMI at baseline, family history of obesity
and lower educational level were independently associated with weight
gain following the use of antidepressants.
The present study has several limitations. First, the study was
conducted among patients attending psychiatric outpatient clinics;
therefore, it might not be representative of all patients receiving antide-
pressants. Second, the study design was cross-sectional and descriptive.
Third, we did not examine psychiatric diagnoses and their effects on
body weight. For example, depression itself may be associated with
weight gain in adults [6]. In addition, we did not measure severity of
depression both at baseline when patients started antidepressants and
over time in this study. These factors are major limitations for the
present study. Finally, that our data on weight before and after antide-
pressant medication, history of medical illnesses, and family history of
obesity and diabetes mellitus were based on the patients’ report is
another major limitation.
In conclusion, the results of this study suggest that most newer anti-
depressants are associated with increased body weight. In particular,
patients with the risk factors described above should be followed with
respect to body weight changes. However, this topic needs further
control studies with a larger sample size.
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