Katherine H. Saunders, MD Leon I. Igel, MD, FACP, DABOM Alpana P. Shukla, MD, MRCP Louis J. Aronne, MD, FACP, DABOM, FTOS Weill Cornell Medicine, New York, NY kph2001@med.cornell.edu
Drs. Saunders, Igel, and Shukla reported no potential conflict of interest relevant to this article.
Dr. Aronne reported that he is a consultant/advisor to Eisai, Gelesis, GI Dynamics, Jamieson Labs, JOVIA Health, Novo Nordisk A/S, Pfizer Inc, and VIVUS; a shareholder of Gelesis, Jamieson Labs, Myos Corp, and Zafgen; and a member of the board of directors of Gelesis, and Myos Corp. Dr. Aronne also reported receiving research funding from Aspire Bariatrics and Eisai.
Bupropion, a norepinephrine and dopamine reuptake inhibitor, is the only antidepressant that has been consistently shown to cause weight loss.30,31 Clinical trials have found that it decreases body weight by suppressing appetite and reducing food cravings.30 Bupropion is approved for the treatment of depression and as a smoking cessation aide. And, in 2014, a bupropion-naltrexone combination received FDA approval for chronic weight management, sold under the brand name Contrave.32
Within classes of antidepressants, there is a range of weight gain potential, which can vary depending on the duration of therapy.
As different classes of antidepressants are often prescribed for different types of depression, it is important to be aware that the few that are weight-neutral and weight-loss-promoting are not appropriate for all patients with depression. For example, bupropion is an activating agent and can exacerbate anxiety. Thus, a patient with concomitant depression and anxiety might be a better candidate for another antidepressant, which could lead to some weight gain but would better manage the individual’s symptoms. In such cases, the rule of thumb should be to prescribe the lowest dose required for clinical efficacy for the shortest duration necessary.
CASE 3 ›Change antidepressants—and keepa close watch
Depending on the nature of Mr. D’s depression, bupropion, fluoxetine, or sertraline might be a reasonable alternative to paroxetine to prevent or reduce further drug-induced weight gain.
Frequent follow-up visits should be scheduled until the transition has been completed and his condition stabilized. If Mr. D’s new antidepressant is bupropion, monitoring him for signs of anxiety would be required.
CORRESPONDENCE Katherine H. Saunders, MD, Comprehensive Weight Control Center, Weill Cornell Medicine, 1165 York Avenue, New York, NY 10065; kph2001@med.cornell.edu.
