- Celexa Begins Working Faster Than Previously Thought
- ‘Tapering off is the hardest thing I’ve ever done’: Sarah, 32; has taken Seroxat for 14 years
- ‘I don’t have much of an interest in interacting romantically or physically with the opposite sex’: Jake, 24; took SSRIs for eight years
- ‘If I missed a dose, I’d get shocks down the side of my body’: Chris, 43; has been taking Seroxat for 26 years
- ‘I wanted to be able to feel good when good things were happening, bad when bad things were happening’
- Does Celexa Cause Weight Gain Or Loss?
- Can Celexa Cause Weight Loss?
- Countering Citalopram Weight Changes
- Bupropion Only Antidepressant Linked to Weight Loss
Celexa Begins Working Faster Than Previously Thought
Most classes of antidepressant medications, including the selective serotonin reuptake inhibitors (SSRIs), are thought to require 2 or more weeks of use before therapeutic effects become noticeable. The consumer guidelines for a drug like Celexa (citalopram) clearly advise patients not to expect immediate benefits but to continue taking their medication as prescribed. However, a recent study has cast doubt on the notion that SSRIs really take weeks to build up to therapeutic levels. If the results are confirmed with subsequent experiments, then our understanding of these medications will be greatly enhanced. Observing the neurochemical mechanism behind specific SSRIs will naturally lead to more beneficial prescribing patterns and better patient outcomes.
In a study of the SSRI Celexa, 26 participants were given either a single dose of the drug or a dose of placebo, a harmless sugar pill. None of the participants had depression, a fact which allowed researchers to study specific physiologic responses without interference. Three hours later, participants were shown images of frightened faces while brain activity in their amygdala was measured via magnetic resonance imaging. Psychiatrists have theorized that hyperactivity in the amygdala is a measurable effect of depression that places the individual in a constant state of heightened anxiety. In the single-dose Celexa study, participants given medication showed a muted response in their amygdala when viewing frightened or anxious faces. Researchers observed a spike in amygdala activity in those who received placebo. These findings demonstrate that potentially therapeutic effects begin as quickly as a few hours after the first dose of Celexa, and by extension any SSRI. Interestingly, none of the participants reported either a change in mood or unusual side effects. The study authors theorize that the action on the amygdala has both immediate benefits on an unconscious level and longer term effects on anxiety.
Depression is often described as a constellation of symptoms and effects. Because of its many manifestations, the disease is a long way from being fully understood. There is currently no fool-proof, one-size-fits-all treatment for depression. Research on antidepressant medications like Celexa helps us identify what’s happening in the depressed brain. Armed with that knowledge, we can tailor more effective medications in the future. The study under discussion, for example, highlights the possibility that Celexa’s beneficial effects begin with the amygdala, the brain’s primitive fear center. More importantly, these effects begin almost immediately, contrary to previous assumptions.
In March this year, members of the BMA, along with MPs and researchers from Roehampton University, went to parliament to lobby Public Health England, armed with research estimating that there are 770,000 long-term users of antidepressants in England alone, at a cost of £44m to the NHS per year (a figure that does not account for the cost of GP appointments, or the impact of side-effects, withdrawal effects and disability payments).
“I think you have to adopt a very conservative approach,” says psychiatrist Jon Jureidini. “These are brain-altering drugs, and our overall experience with brain-altering drugs of all kinds is that they tend to have a detrimental effect on some proportion of people who take them long term. All we know about the benefits is from short-term symptom-reduction studies. The careful prescriber needs to say, ‘Well, in balancing the likely benefits and harms, I need to be very cautious about how much benefit I’m expecting, and I need to be very generous about the possibility that the harms might be more than they appear to be.’”
Quite a few long-term users, such as those I spoke to below (and who wished to be anonymous), would agree.
‘Tapering off is the hardest thing I’ve ever done’: Sarah, 32; has taken Seroxat for 14 years
I was prescribed Seroxat when I was 18, the year I started university. I grew up with a disabled sister, so things at home were very stressful, and I had a history of anxiety and panic attacks. I had counselling, but the problems persisted, so I went back to the GP. I don’t remember everything that was said, but there was no conversation about side-effects.
Within the first two weeks of starting Seroxat, I remember I was sitting in the front room watching TV when out of nowhere I had this intense feeling of heat, like an electric shock. It started in my hands, went all the way up my arms and through to my head.
The GP said it was probably just my body getting used to the drug. And after a few weeks the weird sensations did ease off. I had a fabulous time at university. I still had panic attacks, and there were certain situations I would avoid – as I still do – so it wasn’t a wonder drug, but there were no major problems.
But in 2006 I tried to come off it. There were a couple of Panorama documentaries about the side-effects and I was starting to become concerned. The GP said, “That’s fine, but do it gradually, over three weeks.”
I immediately became incredibly unwell. I thought I was losing my mind. I was going to work, but it was difficult to get through the day. My mouth was so dry, I was constantly drinking water. I had bizarre thoughts – not hallucinations – that were frightening or distressing. I had a strong sense of detachment from reality.
Eventually, the doctor said, “Look, you coming off is obviously not working: we need to get you back to 20mg.” Within a week I was much better.
A few years later, when I realised my mental health was getting worse, even though I was on the medication, I started to do some research, reading case studies about withdrawal. I find it so offensive when a GP says, “This is who you are.” I didn’t have these symptoms 10 years ago. I didn’t have this sense of detachment. I saw various psychiatrists. They just kept saying, “The drug is safe, you need to be on it.” A couple of others told me the reason I was having these problems was because I wasn’t taking enough. Another said, “If you were diabetic, you’d take insulin and you wouldn’t have an issue. Why are you so bothered about taking this drug?”
I’ve been on it since I was 18, so I don’t know who I am without it, as an adult. Who knows? I might have all kinds of problems, but I need to know I’ve tried. Tapering off is the hardest thing I’ve ever done. It’s taken me three years just to get from 20mg to 5mg. I’m no longer with my partner – we were together for six years. I believe Seroxat has played a part: it affected my moods, it made my anxiety worse and, by necessity, I’ve had to be selfish, really. I don’t want to say all my problems are to do with Seroxat, because they’re not. But I do believe that it has caused me harm.
‘I don’t have much of an interest in interacting romantically or physically with the opposite sex’: Jake, 24; took SSRIs for eight years
I had been dealing with symptoms of OCD and anxiety for a lot of my childhood. It’s in my family, affecting two siblings and one parent. I was prescribed Zoloft when I was 12; I took a variety of SSRIs, Zoloft to Prozac to Lexapro, and then two others, for eight years.
Did they help? You know, I can’t really tell you, because I got through school. I got high marks, I had a lot of friends. So, in that sense, they must have helped. That’s the thing: for people with major depression, it’s easy to say, this has a measurable effect. But I kept taking them just because that’s what I’ve always done.
I went to university right out of school. I did very poorly. I had a bit of a breakdown, isolating myself, not sleeping. I was still on medication. I came home and enrolled at a community college. That was my worst period – I was very depressed. And I started to think, “I’ve been on these medications a long time. I’m not doing well – why not get off them?” I don’t recommend this at all to anyone, but I stopped going to a psychiatrist and took myself off.
Prozac. Photograph: Getty Images
For months I had trouble sleeping. I was jittery. I had brain zaps. My anxiety was pretty ramped up. I would feel numbness in my extremities – generally my arms. My psychiatrist told me these were just normal withdrawal symptoms, and they’d be gone in four to six weeks: “Anything you feel beyond that is your anxiety and depression returning.” Basically, if you still feel anything beyond this window that the medical community has established, it’s all in your head.
Eventually I went back to school full-time, and I remember doing OK, feeling somewhat better.
I’ve now been drug-free for four years. What’s lasted are the sexual side-effects. They were definitely worse in withdrawal than they had been on the drug, even though I didn’t really realise or understand it at the time, primarily because I started to take SSRIs at 12. While my brother took the same medicine over the same period and had a normal sexual life, I had a lack of sexual interest. I had erections, and I have regularly masturbated my entire life. But I don’t have much of an interest in interacting romantically or physically with the opposite sex.
I didn’t even start thinking about sex until a couple of years ago. It’s almost like I woke up one day and thought, “OK!” I started getting these windows – days or weeks – when normal sexual feelings would appear. But they’re new to me and I don’t know what to do about them. And because I don’t know what to do, I get anxious, and the anxiety kills any feeling – and then I’m anxious because I’ve lost all my feeling.
Online, I’ve come across a big asexual community. Some also took antidepressants; I think there are a lot of people like me out there. I’d like to think that if I keep going to counselling and sleeping and eating properly, I can rectify these things.
In the end, it’s about pros and cons. If you’re lying in bed and can’t get up, is it better to function? If it was up to me, I’d say that, barring extreme circumstances, nobody under 18 should be prescribed these things. Your brain develops around them. Drug companies should be thinking of the long-term effect on people who can’t even consent.
‘If I missed a dose, I’d get shocks down the side of my body’: Chris, 43; has been taking Seroxat for 26 years
I was originally prescribed Seroxat for mild anxiety about my GCSEs. It was 1991, about the time GlaxoSmithKline released Seroxat. I was one of the first people to be given it.
I was prescribed 20mg, the basic dose, to start with. It helped me: I got through school, I went to uni, I went to work. But I had side-effects from the off: profuse sweating, low libido. I’m quite a placid person, but I became aggressive. I never suffered, in the beginning, with the suicidal thoughts that people talk about now, but what I did notice was that if I missed a dose – especially after eight years of taking it – I’d get shocks down the side of my body. I’d be nauseous, my limbs would become weak. I’d be in a constant state of confusion and was very impatient. I couldn’t communicate well with people. I said this to the doctor, and he said, “We’ll up the dose to 40mg.” That was 1998.
The 10 years after that weren’t too bad. I managed to work, as a sales rep, for 18-20 years. But by 2012, by which time I was up to 60mg, I had tried on numerous occasions to withdraw. I tried to go back to 20mg, but my words became slurry, so the doctor put me back up to 60mg.
By the time I was 38, even that wasn’t enough. I tried to take my life. The doctor wouldn’t prescribe a higher dose. I couldn’t do my job, I couldn’t concentrate, I couldn’t drive. A psychiatrist once said to me that coming off Seroxat is harder than quitting heroin. That really hit home.
I have now been unable to work for four years. I’m still seeing a psychiatrist. I’ve also been diagnosed with fibromyalgia: constant tiredness, aches in the neck, and in the lower back and lower limbs. I’m 43 and still live with my mum and dad.
I also have no libido. Since the age of 30, I have had no feelings in that regard whatsoever. I have had relationships, but they’ve all failed. I haven’t been in a relationship for 10 years, which is a long time to go without sex, but I just don’t get the urge.
I don’t really have emotions, to tell you the truth. The drug takes your emotions away. I’m sort of existing, not living.
‘I wanted to be able to feel good when good things were happening, bad when bad things were happening’
I suppose I was a depression snob. A purist. Why should I take antidepressants? Yes, there was something rubbish about crying all the time, not functioning, being unable to answer simple questions because of the fug in my head. But, hey, at least I was true to myself.
My depression went back to my late teens. I didn’t like to think of myself as depressive, because depressives were losers. And I didn’t think I fitted the bill: I was pretty funny and able, and I could get girlfriends. I guess most depressives don’t think they fit the bill.
It might have been genetic. My dad had paralysing depression, and so did his father. As a young boy, I’d spent three years off school with encephalitis – an inflammation of the brain that is often fatal. Survivors are often left with depression.
I remember as a teenager being on holiday in Greece with friends. The weather was gorgeous, and I thought, “Why can’t it piss down, because then at least I’d have a reason to feel this way?”
That is what I always craved – objectivity. To be able to feel good when good things were happening, to feel bad when bad things were happening. I hated the fact that my feelings rarely correlated to what was going on in my outer world.
In my 20s, I got by. I held down a good job, fell in love, had kids, made friends, had a pretty good life. But things came to a head when my best friend killed herself. I’d find myself weaving in between traffic wondering what the impact would be like. I took a period off work and gratefully accepted my Prozac prescription.
Things had changed since I first rejected them. Prozac looked cool (lovely green-and-white pills) and rock bands wrote great songs about it (even if REM’s Shiny Happy People was supposed to be dystopic). After telling people I was off work with depression, I ended up feeling like a priest at confessional. It turned out that virtually everybody I knew was a depressive and pilling their way out of it; now it was “our secret”.
Initially, Prozac made me feel sick. And then magically, after a couple of weeks, I felt lighter, as if something had been lifted. I could hear questions properly, answer logically, enjoy a sunny day.
My partner said I was transformed. Occasionally, I would try to come off the pills and felt rubbish again – not more rubbish than I had before, but the same. So I returned, and after a while, I thought, “What’s the point of even thinking about coming off the pills if they make life work for me?”
There are times now when I wonder if I weep and fret and withdraw too much, and whether I’m becoming immune to the Prozac. But on balance I think not, because life is still so much better than it was.
If Prozac was no longer working for me, would I stop taking it? Probably. Would I stop taking antidepressants full stop? I doubt it. I’d simply look for another super pill.
• Are you a long-term user of antidepressants? Tell us about your experiences
- If you are affected by the issues raised in this piece, contact the Samaritans here.
- This article was amended on 8 May 2017 to clarify that paroxetine is sold as Paxil in the US and Seroxat in the UK, not the other way around as stated in an earlier version.
Citalopram is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI).
It’s often used to treat depression and also sometimes for panic attacks.
Citalopram helps many people recover from depression, and has fewer unwanted side effects than older antidepressants.
Citalopram is available on prescription as tablets and liquid drops that you put in a drink of water.
- It usually takes 4 to 6 weeks for citalopram to work.
- Side effects such as tiredness, dry mouth and sweating are common. They’re usually mild and go away after a couple of weeks.
- If you and your doctor decide to take you off citalopram, your doctor may recommend reducing your dose gradually to help prevent extra side effects.
- Citalopram is called by the brand name Cipramil.
Citalopram can be taken by adults and children over the age of 12 years.
Check with your doctor before starting to take citalopram if you:
- have had an allergic reaction to citalopram or any other medicines in the past
- have a heart problem – citalopram can speed up or change your heartbeat
- have ever taken any other medicines for depression – some rarely used antidepressants can interact with citalopram to cause very high blood pressure, even when they have been stopped for a few weeks
- are trying to become pregnant, already pregnant or breastfeeding
- have an eye condition called glaucoma – citalopram can increase the pressure in your eye
- have epilepsy or are having electroconvulsive treatment – citalopram may increase your risk of having a seizure
If you have diabetes, citalopram can make it more difficult to keep your blood sugar stable.
Monitor your blood sugar more often for the first few weeks of treatment with citalopram and adjust your diabetes treatment if necessary.
Take citalopram once a day. You can take it with or without food.
You can take citalopram at any time of day, as long as you stick to the same time every day.
If you have trouble sleeping, it’s best to take it in the morning.
How much to take
Citalopram tablets come in different strengths ranging from 10mg to 40mg.
The usual dose of citalopram is 20mg a day in adults. But it may be started at a lower dose and increased to a maximum dose of 40mg a day.
If you’re over 65, or have liver problems, the maximum recommended dose is 20mg a day.
The usual dose of citalopram in children is 10mg a day, but this may be increased to 40mg a day.
With liquid drops of citalopram, 4 drops is equivalent to a 10mg tablet.
What if I forget to take it?
If you occasionally forget to take a dose, don’t worry. Take your next dose the next day at the usual time. Never take 2 doses at the same time to make up for a forgotten one.
If you forget doses often, it may help to set an alarm to remind you.
You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
The amount of citalopram that can lead to an overdose varies from person to person.
Like all medicines, citalopram can cause side effects in some people, but many people have no side effects or only minor ones.
Some of the common side effects of citalopram will gradually improve as your body gets used to it.
Some people who take citalopram for panic attacks find their anxiety gets worse during the first few weeks of treatment.
This usually wears off after a few weeks, but speak to your doctor if it bothers you – a lower dose may help reduce your symptoms.
Common side effects
Common side effects happen in more than 1 in 100 people. Keep taking the medicine, but talk to your doctor or pharmacist if these side effects bother you or don’t go away:
- dry mouth
- sweating a lot
- being unable to sleep
- feeling sleepy
- feeling tired or weak
Serious side effects
Serious side effects are rare and happen in less than 1 in 1,000 people.
Go to A&E immediately if you get:
- chest pain or pressure or shortness of breath
- severe dizziness or passing out
- painful erections that last longer than 4 hours – this may happen even when you’re not having sex
- any bleeding that’s very bad or you can’t stop, such as cuts or nosebleeds that don’t stop within 10 minutes
Call a doctor straight away if you get:
- thoughts about harming yourself or ending your life
- constant headaches, long-lasting confusion or weakness, or frequent muscle cramps – these can all be signs of low sodium levels in your blood (in severe cases low sodium can lead to seizures)
- vomiting blood or dark vomit, coughing up blood, blood in your pee, black or red poo – these can be signs of bleeding from the gut
- bleeding from the gums or bruises that appear without a reason or that get bigger
Book an appointment with your doctor if you experience:
- changes in your periods, such as heavy bleeding, spotting or bleeding between periods
- weight gain or weight loss without trying
Serious allergic reaction
In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to citalopram.
These aren’t all the side effects of citalopram.
For a full list, see the leaflet inside your medicines packet.
What to do about:
- dry mouth – chew sugar-free gum or sugar-free sweets
- sweating a lot – try wearing loose clothing, use a strong anti-perspirant and keep cool using a fan if possible. If this doesn’t help, you may need to try a different type of antidepressant.
- being unable to sleep – take citalopram first thing in the morning
- feeling sleepy – take citalopram in the evening and cut down the amount of alcohol you drink. Do not drive or use tools or machinery if you’re feeling sleepy. If this doesn’t help, talk to your doctor.
- feeling tired or weak – do not drive or use tools or machinery if you’re feeling tired. Cut down the amount of alcohol you drink as it can make you feel worse.
It’s important for you and your baby that you stay well during your pregnancy.
If you become pregnant while taking citalopram, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.
Citalopram has been linked to a very small increased risk of problems for your unborn baby.
But if your depression isn’t treated during pregnancy, this can also increase the chance of problems.
You may need to take citalopram during pregnancy if you need it to remain well.
Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.
For more information about how citalopram can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPS) website.
Citalopram and breastfeeding
If your doctor or health visitor says your baby is healthy, citalopram can be used during breastfeeding.
Citalopram passes into breast milk in small amounts, and has been linked with side effects in very few breastfed babies.
It’s important to continue taking citalopram to keep you well. Breastfeeding will also benefit both you and your baby.
If you notice that your baby isn’t feeding as well as usual or seems unusually sleepy, or you have any other concerns about your baby, talk to your health visitor or doctor as soon as possible.
Some medicines and citalopram can interfere with each other and increase the chances of you having side effects.
Tell your doctor if you’re taking these medicines before you start citalopram:
- any medicines that affect your heartbeat – citalopram can speed up or change your heartbeat
- any other medicines for depression – some rarely used antidepressants can interact with citalopram to cause very high blood pressure even when they have been stopped for a few weeks
Mixing citalopram with herbal remedies and supplements
Do not take St John’s wort, the herbal remedy for depression, while you’re being treated with citalopram as this will increase your risk of side effects.
Does Celexa Cause Weight Gain Or Loss?
Factors That Influence Weight Gain On Celexa
The amount of weight someone puts on while on Celexa depends on various factors and varies from one person to another. However, citalopram weight gain can be a sign of improvement to those patients who have lost weight due to depression. It will only be considered a side effect if the patient continues to gain even after full remission of depressive symptoms. Here are the factors that influence weight gain on citalopram:
- The period of use, those who have used the drug longer are more likely to gain weight.
- The dosage, the higher the dosage, the more likely someone will add extra pounds.
- Individual factors such as dietary intake, environmental stress, and baseline metabolism.
- Combining the drug with other medications.
Tips For Losing Extra Weight After Taking Celexa
It is not recommended to stop taking citalopram immediately once there is a notable increase in mass because of the possible withdrawal symptoms. Furthermore, people who gain weight on Celexa should consult a medical professional who will advise them accordingly on how to taper off the medication and manage the situation.
Here is a list of measure that one can take to lose the extra pounds after citalopram weight gain:
- Stay active by joining a gym, taking up activities such as bike riding or jogging every morning. Such activities will allow the body to burn the extra calories. Studies also suggest that people who keep a daily workout routine are generally happier than those who do not.
- Maintain a healthy diet which includes eating less particular carbohydrate foods. Consult a nutritionist who will recommend a healthy food regimen. A theory suggests that people taking Celexa usually crave carbohydrate foods; this increases their consumption of these foods.
- Consider changing antidepressant medication but do so after consulting with the doctor. The doctor may prescribe another Selective Serotonin Reuptake Inhibitor that does not have this side effect.
Can Celexa Cause Weight Loss?
Citalopram can cause weight loss during the first few weeks of use. Abrupt stopping Citalopram use also will cause withdrawal symptoms such as nausea and loss of appetite that may cause patients to become slimmer. Studies have shown that more than one percent of depression patients have exhibited citalopram weight loss as a result of use with some of them losing insignificant amounts. However, some patients lose considerable amounts as well.
Depression may often cause an increase in mass in some people because of the tendency to overeat. According to the U.S National Library of Medicine, depression is more severe among obese patients. Therefore, once treatment is commenced using antidepressants such as citalopram, these patients tend to lose weight because of the reverse effects caused by depression.
Countering Citalopram Weight Changes
Working closely with a medical doctor is the best way to counter citalopram weight gain or loss that are accustomed to antidepressant use. The doctor will assess the situation and can suggest a safe strategy for adjusting body mass to a normal state. Without a doctor, patients can adopt a healthy lifestyle such as a routine workout and eating a balanced and healthy diet so that they reduce the extra Celexa gained weight. Some patient may prefer to recover under close medical supervision in the rehabilitation facilities which provide various treatment programs.
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Bupropion Only Antidepressant Linked to Weight Loss
Bupropion is the only antidepressant associated with modest long-term weight loss, but only among nonsmokers, according to a new retrospective cohort study published recently in the Journal of Clinical Medicine.
“We found that bupropion is the only antidepressant that tends to be linked to weight loss over 2 years,” study leader David Arterburn, MD, Group Health Research Institute, Seattle, Washington, said in a Group Health Research Institute news release. “All other antidepressants are linked to varying degrees of weight gain.”
“Our study suggests that bupropion is the best initial choice of antidepressant for the vast majority of Americans who have depression and are overweight or obese,” he added.
Only Nonsmokers Lost Weight With Bupropion
Dr Arterburn and colleagues studied the relationship between antidepressant choice and weight change over 2 years among adults with a new prescription for antidepressant therapy.
“Because one of the most commonly prescribed antidepressants, bupropion, is also used as an adjunct to smoking cessation, and smoking cessation is strongly associated with weight gain, we sought to examine the effects of this antidepressant on weight gain among smokers and nonsmokers separately,” the authors write.
They conducted a retrospective electronic health record–based cohort study of adult patients who began monotherapy with second-generation antidepressant treatment between 2005 and 2009. They used fluoxetine as the reference treatment and included citalopram, bupropion, paroxetine, sertraline, trazodone, mirtazapine, venlafaxine, and duloxetine.
The researchers adjusted for potential confounders present at baseline, including age, sex, history of anxiety disorder, bipolar disorder, sleep disorder, schizophrenia and schizoaffective disorders, and smoking status at the time of beginning antidepressant treatment.
Bupropion was the only medication associated with a significantly different estimate of weight loss at 2 years when compared with fluoxetine, and this finding was seen only in nonsmokers.
After adjustment for confounders, nonsmokers who began treatment with bupropion lost, on average, 7.1 pounds compared with nonsmokers who used fluoxetine (P < .01).
The results were different in those who smoked, however. Smokers who used bupropion gained, on average, 2.1 pounds compared with smokers who used fluoxetine, although this difference was not significant (P = .33).
Those who used mirtazapine gained, on average, an estimated 11.6 pounds compared with those who used fluoxetine (P = .12). This difference was not statistically significant, probably because of the small number of patients who began mirtazapine.
And with the exception of sertraline, the remaining antidepressant-drug weight-change estimates did not differ significantly from fluoxetine. Those who used sertraline gained, on average, 5.9 pounds compared with those who used fluoxetine (P = .02).
Choose Bupropion for Nonsmokers With Obesity and No Contraindications
“Obesity and depression…commonly occur together, and adults with both conditions may have even greater health risks. The causal pathway is probably bidirectional — obese adults are at greater risk of depression and vice versa,” the authors write.
But bupropion is not appropriate for all patients, including those with a history of seizure disorder, they note.
“In conclusion, we find that bupropion is the only antidepressant associated with long-term weight loss (although this effect is limited to nonsmokers).”
“Given similar efficacy for improvement in depressive symptoms across bupropion and other second-generation antidepressants, bupropion may be considered the first-line drug of choice for overweight and obese patients unless there are other existing contraindications,” they surmise.
Coauthor Gregory Simon, MD, Group Health, Group Health Research Institute, and University of Washington School of Medicine, Seattle, agrees, commenting in the news release: “A large body of evidence indicates no difference in how effectively the newer antidepressants improve people’s moods.”
“So it makes sense for doctors and patients to choose antidepressants on the basis of their side effects, costs, and patients’ preferences — and, now, on whether patients are overweight or obese,” Dr Simon concluded.
The authors have disclosed no relevant financial relationships.
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J Clin Med. Published online April 13, 206. Article