Will Coming Off Citalopram Help Me Lose Weight

Mental health is essential to your overall quality of life and sense of well-being.  Globally, depression affects 17% of the population and is expected to increase to almost one in four individuals by 2030. Depression is a common obesity-related health condition and the two can be so interconnected that it is sometimes even difficult to determine which came first – feelings of depression or struggles with weight. Unfortunately, antidepressants, which are the most commonly recommended treatment for moderate to severe depression, often cause significant weight gain.

First, antidepressants are effective. In fact, 89% of individuals with depression report that medication improves their symptoms. Unfortunately, weight gain is the 3rd most commonly reported negative side effect behind withdrawal effects and sexual dysfunction. Weight gain has been reported by 65% of individuals on long-term antidepressant therapy, while only 15% of individuals on antidepressants reported weight-loss.

Furthermore, the length of antidepressant therapy seems to matter. In a patient-reported survey, those on antidepressants for more than three years had more severe side effects than patients on therapy for less than two years, with weight gain being one of main reported side effects.

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Both changes in weight depend on the length of antidepressant therapy and choice of medication. Additionally, the body’s response to medication can change over time.

For example, let us consider a common class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). This class includes medications that are used frequently like:

They help with depression by blocking the reuptake of serotonin, a hormone in the brain that stabilizes our mood, feelings of well-being, and happiness. Serotonin levels are lower in people with depression and SSRIs help increase the amount of serotonin that is available to the brain. In the short-term, this increase in serotonin helps us feel full, decreases our food intake, and decreases our impulsiveness. But in the long-term, our body seems to adjust to these changes in stimulation. After 12 months of treatment, an SSRI can sometimes lead to weight gain due to cravings for carbohydrates and other potential factors.

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Another factor that plays a role in weight while on antidepressants is whether or not you are struggling with obesity at the time the medication is initiated. For example, antidepressant medications that increase dopamine levels in the brain also affect energy balance. Individuals with obesity tend to have decreased dopamine, which is a chemical in the brain that influences mood as well as feelings of reward and motivation. Improving dopamine levels may help them lose weight. However, individuals without obesity may gain weight in response to an increase in dopamine signaling. This is a perfect example of how intertwined these two diseases can become as we try to improve one or both.

By following patients over time, we have been able to categorize antidepressants based on their risk of “drug-induced weight gain.” In the chart featured in this article, you will see that medications can be high, medium or low-risk.

When possible, it is beneficial to choose from medications that have a lower risk of weight gain. In fact, with the help of your physician or psychiatrist, you may find that you want to trying shifting to a lower-risk medication.

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In summary, there are many pieces to the puzzle when it comes to treating obesity while also taking antidepressants. The journey must be individualized. If depression and obesity are two areas that you are working on as you strive to improve your health, then it is time to map out your plan. You know your body best, so always be sure to tell your healthcare provider about any struggles you may be having with depression or weight gain. You can work together to develop a plan that meets your mental and physical needs.

Deborah Horn, DO, MPH, MFOMA, is the President of the Obesity Medicine Association and Clinical Assistant Professor in the Department of Surgery at The University of Texas McGovern Medical School at Houston. She is the Medical Director for the UTHealth Center for Obesity Medicine and Metabolic Performance. Dr. Horn was also the recipient of the Obesity Action Coalition’s (OAC) Healthcare Provider Advocate of the Year award – an award given to a healthcare provider who is a tireless advocate for patients, the OAC and the cause of obesity.The content in this leaflet is provided for general information only. It is not intended to, and does not, mount to advice which you should rely on. It is not in any way an alternative to specific advice.

You must therefore obtain the relevant professional or specialist advice before taking, or refraining from, any action based on the information in this leaflet.

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They are medications prescribed for depressive illness, anxiety disorder or obsessive-compulsive disorder (OCD). You can find out more about how they work, why they are prescribed, their effects and side-effects, and alternative treatments in our separate resource on antidepressants.

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Usually, you don’t need to take antidepressants for more than 6 to 12 months. While they can make you feel better, you can get withdrawal symptoms when you stop taking them. Some people will get no symptoms when reducing or stopping an antidepressant – but many do. These symptoms can be physical and mental, although they are different for everyone – and they can be different for individual antidepressants (see Appendix 1).

This resource aims to help you avoid getting any withdrawal symptoms – or get the fewest possible. Talk this over with your doctor so you can find the best way to stop taking them.

The NICE guidelines suggest that for some, withdrawal symptoms can be mild and go away relatively quickly, without the need for any help. Other people can have more severe symptoms which last much longer (sometimes months or more).

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This is still poorly understood. Brain chemicals called neurotransmitters (such as serotonin and noradrenaline) are involved. They allow nerve cells to communicate with each other by acting on nerve endings. Antidepressants increase levels of these chemicals in the space between nerve cells in the brain. Over time, the brain seems to slowly adjust to these increased levels.

If an antidepressant is stopped quickly, the brain will need time to adjust back again. The sudden lowering of neurotransmitter levels seems to produce withdrawal symptoms, while the brain adjusts to the change. The more gradual the changes, the milder and more tolerable symptoms should be – or, indeed, they may not happen at all.

Between a third and half of people who take an antidepressant will experience such symptoms to some extent. We cannot yet predict who will get these symptoms.

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The risk seems to be greater if you have taken a high dose for a long time, but it can happen if you have taken an antidepressant for just a month. It can also depend on the type of antidepressant you have been taking. You are more likely to get these symptoms (and for them to be worse) if you stop taking an antidepressant suddenly or if you reduce the dose quickly.

Some withdrawal symptoms can feel like the symptoms you had before you started the antidepressant. The low mood and difficulty in sleeping of withdrawal can feel like the symptoms of depression. Dizziness is a common symptom of anxiety. In this case, you should carry on taking your antidepressant at the prescribed dose – and talk with your doctor.

If you do get withdrawal symptoms, you can still stop your antidepressant – but may need to do so more slowly (see section on ‘When and how to stop antidepressants’).

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These are some of the ways you and your doctor can tell whether you are having withdrawal symptoms or whether it is the symptoms of a return of anxiety or depression:

Stopping an antidepressant can give you unpleasant withdrawal symptoms – which stop if you start taking it again. It can certainly feel as though you are addicted to the antidepressant – but it’s not quite the same as being addicted.

You don’t get the craving or constantly having to increase the dose that you do with substances like alcohol, nicotine or benzodiazepines. But it can still be hard to stop taking an antidepressant.

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How long you take an antidepressant for depends on why you were prescribed them and whether you have had to take them before. Ask your doctor when is best to start to reduce and then stop taking your antidepressant.

When you agree that it is time to stop, your doctor can help you put together a withdrawal plan. This must be flexible. It should allow you to reduce the dose at a rate that you find comfortable – as slowly as you need to avoid distressing withdrawal symptoms. This is also called ‘dose tapering’. Dose reductions will usually get smaller as the dose decreases