**Антидепрессанты и вес. Почему на антидепрессантах растёт вес? — Transcript & Summary | SozAI** Source: https://sozai.app/transcript/antidepressants-weight-gain-explained/ Exploring the complex relationship between antidepressants and weight changes, including mechanisms, drug differences, and practical advice. ## Key Takeaways - Weight gain on antidepressants is drug-specific and varies over time. - Mechanisms include increased appetite and reduced physical activity, not calories in pills. - Weight changes may reflect recovery from depression-related appetite loss. - Lifestyle adjustments and professional guidance are important for managing weight. - Simplistic claims about supplements or quick fixes for cravings are misleading. ## What the video covers - Not all antidepressants cause weight gain; effects vary by drug and treatment duration. - Short-term studies show mixed results, with some drugs causing initial weight loss and others weight gain. - Long-term data indicate drugs like paroxetine may cause more weight gain compared to others like sertraline. - Weight gain associated with antidepressants is generally moderate, around 5% of body weight per year. - Weight changes are influenced by increased appetite, decreased physical activity, and return to pre-depression weight. - Antidepressants affect brain systems controlling hunger and satiety, e.g., mirtazapine blocks histamine receptors increasing appetite. - Behavioral and lifestyle changes play a significant role in weight fluctuations during antidepressant treatment. - Eating behavior is complex and cannot be simplified to single nutrient or supplement fixes. - Monitoring weight and consulting healthcare professionals for diet and activity adjustments is recommended. - Individual responses vary greatly, requiring personalized approaches to managing weight during antidepressant use. ## Chapters 1. 00:00 Introduction to Antidepressants and Weight 2. 01:17 Study Results on Weight Changes by Drug 3. 02:46 Long-Term Effects and Variability in Weight Gain 4. 04:18 Magnitude of Weight Gain and Study Limitations 5. 05:48 Mechanisms Behind Weight Changes 6. 07:06 Behavioral and Lifestyle Factors 7. 08:30 Complexity of Eating Behavior and Misconceptions 8. 10:14 Practical Advice and Professional Support 9. 12:09 Conclusion and Next Steps Answers ## Questions about this video Do all antidepressants cause weight gain? No, not all antidepressants cause weight gain. Some drugs like amitriptyline are associated with weight gain, while others like fluoxetine may cause weight loss or no significant change. Why do antidepressants cause weight gain if they contain no calories? Weight gain is linked to increased appetite and decreased physical activity caused by antidepressants affecting brain systems controlling hunger and satiety, not because the pills contain calories. How much weight gain is typically associated with antidepressant use? Studies suggest a moderate weight gain of about 5% of body weight per year, which for a 70 kg person is roughly 3.5 kg, but this varies by drug and individual factors. ## Full Transcript — Download SRT & Markdown 00:00 Speaker A Hello, and welcome to Dr. Burlakov's channel. Today, we are going to talk about antidepressants and body weight. 00:08 Speaker A What exactly will we be discussing? We’ll talk about which drugs studies associate with weight gain, which ones with weight loss, and where there is no visible difference. We’ll talk about the mechanism. I mean, it seems like antidepressant pills contain no 00:23 Speaker A calories. Or practically none, let's say. So, where does the weight gain come from, if it actually happens? And we will discuss what to do in practice regarding all these effects that some people notice while on antidepressants. 00:41 Speaker A Let's start with this question: are all antidepressants associated with weight gain? No, not all of them. A major review was published in 2025, compiling nearly 170 studies. It included about 58,000 people and 30 different drugs. 00:59 Speaker A Each drug was compared to a placebo, that is, a dummy pill with no active ingredient. The results varied in different directions. For instance, with amitriptyline, the weight was on average about 1.5 kg higher than with the placebo. But with fluoxetine, for 01:17 Speaker A example, the weight on average appeared even slightly lower than with the placebo. With escitalopram, no significant difference was found, but all these studies have important limitations. The trials lasted from 3 to 12 weeks. Most often, it was around 01:35 Speaker A 2 months. And we understand perfectly well that antidepressants are prescribed for the long term—for months or even years. Therefore, the question arises: what happens in the long run? And what do we see here? A 2010 review that combined 116 studies. 01:58 Speaker A What was seen in it is that fluoxetine is associated with weight loss in the first months, but then this effect disappears in subsequent months. 02:08 Speaker A Paroxetine shows a similar story. In 2024, American researchers took medical data from over 180,000 people who started treatment and compared the drugs against each other. After six months, the weight gain on paroxetine was higher than on sertraline. It turns 02:27 Speaker A out that in short trials, paroxetine doesn't add weight, but with long-term use, there is an association that body weight increases if you compare it to sertraline. To put it very briefly, maybe it’s not clear to some people right now, who knows. Studies differ on 02:46 Speaker A the question of whether body weight increases or not. In some drugs, as you can see, weight gain is noted only at the early stage of treatment, while for others, it appears after some time, and so on. Therefore, we are interested in 03:06 Speaker A knowing what the size of the effect is. So, how much of a weight gain is usually noted in studies, if it is noted at all? Here is a British study from 2018. They observed 300,000 adults for up to 10 years, counting cases 03:22 Speaker A where a person gained 5% or more of their body weight in a year. So, for a person weighing 70 kg, that would be 3.5 kg. Among those prescribed antidepressants, there were about 11 such cases per every 100 person-years, compared to about eight for those 03:40 Speaker A without a prescription. And 100 person-years, well, that's, for example, 100 people observed for one year. But this was an observation, no one was conducting an experiment, so people with and without depression differ in many ways, and you cannot fully isolate 03:58 Speaker A the drug from that. There you go. And regarding the gain, you see here they even set a cutoff of 5% per year. So, yes, that is the size of the effect that was expected here. And, overall, this value is not very high. So, we 04:18 Speaker A cannot say that taking antidepressants is associated with gaining 10, 20, or 30 kg. Right. If even in studies, they set the cutoff at approximately 5%. Now the question arises, where does this increase in body mass actually come from? We understand perfectly well that 04:39 Speaker A there are practically no calories in a pill. So, antidepressants cannot store fat out of nothing, out of thin air, dark matter, or some otherworldly matter, because fat storage only happens when more food energy enters the body than the body spends. And 05:00 Speaker A accordingly, what mechanisms could be involved here? The first is intake. So, if hunger increases, portions might grow unnoticed, maybe a person serves themselves a little bit more food or there are extra snacks they don't pay attention to. And so we get an excess 05:21 Speaker A of food energy that can potentially be stored in adipose tissue. The next point is, of course, energy expenditure. If a person starts moving less, then even the same amount of food might turn out to be excessive. Here, again, we 05:37 Speaker A shouldn't blame anyone, because some people dismiss it by saying, "Oh, you're making all that up, the drugs contain no calories." "What kind of weight gain are you even talking about? 05:48 Speaker A " Well, some people understand that the drugs contain no calories, no food energy. Right. But they note that certain behavioral changes occur, like increased appetite, and motivation for physical activity might decrease. Right. Therefore, this issue is still worth 06:08 Speaker A considering. And consider it from the perspective that some changes in a person's lifestyle are necessary to address the changes in body weight that occur while taking these medications. 06:24 Speaker A Although, as I said, we cannot definitively state whether there is an association with weight gain. 06:29 Speaker A Everything depends on the duration of the studies and the specific medications. And if we dig deeper, naturally, it depends on a large number of factors. So, here is another interesting point: lost weight can be restored because, for some people, 06:46 Speaker A depression is accompanied by a loss of appetite. A person may force themselves to eat for weeks, consuming less energy than they need, and, naturally, their body weight decreases. But when medication is prescribed and treatment begins to work, appetite returns, and 07:06 Speaker A weight comes back with it. There. That is, it may look like the person gained weight from the pills, even though it might just be a return to their usual state, that is, the state they were in before the depression. Of course, the 07:22 Speaker A data is also inconsistent, and not all depressive episodes are accompanied by a decrease in appetite, because some people, on the contrary, may compensate for this state by consuming more food. 07:39 Speaker A So it can vary significantly from person to person. We even have some studies, for example, the 1999 trials on fluoxetine. At first, everyone was treated with fluoxetine until their condition improved, then people were randomly divided. Some continued the 07:59 Speaker A medication, others switched to a placebo, and they were observed for a year. For those who completed the full term, the weight gain was similar in both groups, about 3 kg. So the weight increased even without the medication, right? That is why the data is actually 08:14 Speaker A so fragmented. This brings us back to the point that eating behavior is quite complex. And when such conclusions are drawn, especially on social media, like "craving sweets? Take chromium" or "magnesium will reduce food cravings" or anything else—it's absolute nonsense! 08:30 Speaker A Because eating behavior is so complex and so deeply integrated into various individual characteristics and behavioral responses that, as you can see, even a seemingly simple question... Are antidepressants associated with weight gain? We cannot give a precise answer because you can see how much the 08:53 Speaker A data varies in principle. Now, as I have already said, some medications do increase hunger. And, in principle, this is the most frequently noted effect for those people who associate weight gain with antidepressants, because antidepressants can affect the brain systems that control hunger and 09:16 Speaker A satiety. For example, with mirtazapine, it blocks histamine type 1 receptors. Histamine in the brain helps you feel full. Naturally, this is not the only neurotransmitter in the brain, but nevertheless, it is one that it acts upon. And when the signal is muffled, 09:34 Speaker A you want to eat more. By the way, sometimes it is specifically prescribed to those who, conversely, have stopped eating due to depression, so that the person doesn't drop to a low body mass index or deve 09:50 Speaker A like that. We clearly understand that, again, the feeling of hunger depends not only on the medication itself, but also on dietary factors and the course of the disease itself. Therefore, if a patient naturally notices that their feeling of hunger is increasing, this 10:14 Speaker A is a reason to discuss it with a doctor , and perhaps discuss it with a nutrition specialist who can help put together a food basket. In this way, there would be more products that have greater satiety, like protein products, 10:28 Speaker A vegetables, and fruits, but just getting motivated to start eating enough protein, vegetables, and fruit is also not a very simple story, especially for those experiencing, for example, depression. That is why here, of course, it is sometimes worth working directly with a specialist. Now 10:45 Speaker A , regarding energy expenditure. Some antidepressants cause drowsiness. Accordingly, this can affect physical activity, both daily physical activity and targeted physical activity, such as workouts in the gym, for instance. 11:03 Speaker A Meaning, the person starts moving less. Well, in principle, I think you perfectly understand what happens. And regarding the thesis often heard that antidepressants slow down metabolism. 11:16 Speaker A No, they cannot somehow break your metabolism. And in general, such a term as "metabolic rate" is somewhat ephemeral because it isn't entirely accurate; although it is found in scientific literature, in scientific literature, "rate" refers to the amount of energy the body expends per unit of 11:36 Speaker A time in a specific context. So. But as I said, it can affect these behavioral reactions of a person, motivation for physical activity, and drowsiness and other such factors, which, of course, can exacerbate an already low level of physical activity for a person. 11:57 Speaker A Therefore, naturally, this aspect can also exist. And, naturally, this will also contribute to weight management and a person's body weight in general. 12:07 Speaker A That is, a person might not even change their eating habits. They may continue to eat the same way, but nonetheless start moving less. And they may not always be able to notice, realize, or even assess it, because these decreases 12:20 Speaker A can be small and sustained over a long period, lasting months, or even a year or two or three, and be related to reduced daily physical activity. A person might start spending a little less time cleaning, for example, without even realizing it; they might 12:37 Speaker A not even notice it. They might walk to the store less often, and start ordering delivery more frequently. 12:43 Speaker A These can be such minimal changes that a person may not even be aware of them, but they can ultimately affect their body weight. Now, what should you discuss with your doctor? Naturally, the first important point is that you 13:02 Speaker A should never stop or change your medication on your own. Before treatment, you can discuss with your doctor how much the given medication is associated with weight gain. So that when you start treatment, you already understand that, for instance, this 13:21 Speaker A drug might increase your appetite, and you could develop a nutrition strategy. And during treatment, monitoring your body weight and checking it periodically is a normal thing to do. 13:36 Speaker A I'm not talking about daily weighing, but in general, maybe weighing yourself once a month, because many people have no idea what their weight is and don't track their height or weight. Right. 13:50 Speaker A And they may not notice the dynamics of weight loss or weight gain. Only when some, let's say, issues with clothing fit arise does a person tend to notice it. Right. So, it would be a good idea if you are taking these medications, or 14:09 Speaker A are worried, or if there is a known association, to weigh yourself, say, once a week and look at the trend. 14:18 Speaker A Right. And when stopping treatment, for example, you must remember that it is possible for symptoms of depression to return, or the symptoms for which the medication was prescribed. This is yet another reason why stopping the medication, lowering the dose, and so 14:42 Speaker A on, should naturally be handled by your doctor and not on your own. Because the logic of "let's say my appetite increased on this medication, so I’ll just adjust it myself and take a little less"—it doesn't work. It doesn’t 14:55 Speaker A work in the sense that the dose might be insufficient to treat the condition for which the antidepressant was prescribed. And it might not really affect your appetite, which could remain the same—still increased, for example—while the primary condition remains untreated. Yeah. And some 15:16 Speaker A simple recommendations: if hunger increases, plan your main meals in advance, keep convenient food on hand, and definitely keep fruits, vegetables, and proteins at home, as these are foods with a high satiety index. If it's hard to plan your diet, you can 15:40 Speaker A see a nutritionist to help you create a meal plan and adjust it so that these hunger episodes bother you less. If drowsiness occurs, you naturally need to discuss it with your doctor, because drowsiness is such a vague concept. How 15:57 Speaker A much it bothers the person specifically , and how much this sleepiness affects daily chores, work, and so on. And if it bothers them and makes it uncomfortable to lead a normal life, then naturally it’s worth discussing with the doctor to change the 16:15 Speaker A medication, dosage, and so on. Yeah. And if it’s hard to stick to a routine, look for small, manageable changes and, of course, seek support. 16:26 Speaker A Yeah. So, if you lack the motivation to go to the gym but realize you need to increase your physical activity because you’ve become less active, it’s worth discussing, say, with your spouse , the idea of going to the gym together 16:45 Speaker A or taking walks together, and so on. So , support is also very important—this social support—because it will provide additional motivation. It will create a certain routine. And as a rule , everything is just more fun together, right? Maintain sufficient physical 17:03 Speaker A activity. Yeah. That criticism of "just eat less and stop whining." But that criticism is wrong, because you need to work through this, since many people realize, "Yes, I need to eat less and move more." How do I incorporate this 17:18 Speaker A into my daily life when I've been diagnosed with depression, prescribed medication, and now I have increased hunger, drowsiness, plus I have kids, work, and other problems? How can I change all of this? Well, sometimes it's not as simple as it looks in 17:32 Speaker A theory. That's why I remind healthcare professionals not to fall into making statements like "just eat less and stop complaining." No, we need to help the person figure out how to organize their daily life properly. A question that also arises is whether it is even 17:49 Speaker A possible to lose weight during treatment? The point is, is it realistic to lose weight when you've been prescribed antidepressants? And the answer is definitely yes, because the laws of thermodynamics apply regardless of whether a person takes antidepressants or not. We have various 18:08 Speaker A studies on this, showing that on these medications, if a person maintains a calorie deficit and increases physical activity, then naturally, their body weight will decrease. So, they don't break the metabolism or block fat burning in any way. The only thing is 18:29 Speaker A that, depending on the specific condition, you might need professional help, because if your hunger is already increasing and you're also in a calorie deficit, that could lead to binge eating and so on. Therefore, organizing a diet in this situation often requires 18:48 Speaker A a more skillful approach. Right. So, what general conclusions can we draw? There is no single universal effect of antidepressants on weight. It's a highly debatable topic. You have to look at specific medications, the duration of treatment, and individual 19:08 Speaker A characteristics, because some can indeed increase hunger and cause drowsiness. This can change both eating habits and energy expenditure. But we must remember that weight gain during treatment isn't always caused by the medication—it may be associated with the illness itself—and while fat 19:30 Speaker A doesn't appear out of nowhere, we shouldn't oversimplify it to "oh, just eat less and don't whine." Naturally, we need to work on these factors and help the person organize their diet and physical activity so they can stick to 19:44 Speaker A the plan. That's basically all I have to say. Thank you very much for your attention. If you have any ideas for topics for future videos, be sure to write them down; I read the comments and will consider them. Maybe I'll make 19:59 Speaker A the next video on that topic. Thank you very much for your attention. Bye. Topics: antidepressants weight gain weight loss depression treatment mirtazapine fluoxetine paroxetine appetite body weight side effects Study this video - [Flashcards from this video](https://sozai.app/tools/ai-flashcard-generator/?from=transcript&id=75089) - [Quiz on this video](https://sozai.app/tools/quiz-generator/?from=transcript&id=75089) Free, made by AI from this transcript. No signup. --- This is the markdown twin of https://sozai.app/transcript/antidepressants-weight-gain-explained/ — the same content, without the markup. 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