How Much Weight Gain Do Antidepressants Cause?
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There’s a lot of talk in the news lately about antidepressants and weight gain, so let’s look at some numbers.
Here’s a study from July 2024 that compared the weight gain of eight popular antidepressants, and pop-science outlets have reported it with such snippets as:
❝Bupropion users were approximately 15–20% less likely to gain a clinically significant amount of weight than those taking the most common medication, sertraline.
The researchers considered weight gain of 5% or more as clinically significant.❞
Read in full: Study compares weight gain across eight common antidepressants
At this point, you might (especially if you or a loved one is on sertraline) be grabbing a calculator and seeing what 5% of your weight is, and might be concerned at the implications.
However, this is a little like if, in our This or That section, we were to report that food A has 17x more potassium than food B, without mentioning that food A has 0.01mg/100g and food A has 0.17mg/100g, and thus that, while technically “17x more”, the difference is trivial.
As a quick aside: we do, by the way, try to note when things like that might skew the stats and either wipe them out by not mentioning that they contain potassium at all (as they barely do), or if it’s a bit more, describing them as being “approximately equal in potassium” or else draw attention to the “but the amounts are trivial in both cases”.
Back to the antidepressants: in fact, for those two antidepressants compared in that snippet, the truth is (when we go looking in the actual research paper and the data within):
- sertraline was associated with an average weight change of +1.5kg (just over 3lb) over the course of 24 months
- bupropion was associated with an average weight change of +0.5kg (just under 1lb) over the course of 24 months
Sertraline being the most weight-gain-inducing of the 8 drugs compared, and bupropion being the least, this means (with them both having fairly even curves):
- sertraline being associated with an average weight change of 0.06kg (about 2oz) per month
- bupropion being associated with an average weight change of 0.02kg (less than 1oz) per month
For all eight, see the chart here in the paper itself:
Medication-Induced Weight Change Across Common Antidepressant Treatments ← we’ve made the link go straight to the chart, for your convenience, but you can also read the whole paper there
While you’re there, you might also see that for some antidepressants, such as duloxetine, fluoxetine, and venlafaxine, there’s an initial weight gain, but then it clearly hits a plateau and weight ceases to change after a certain point, which is worth considering too, since “you’ll gain a little bit of weight and then stay at that weight” is a very different prognosis from “you’ll gain a bit of weight and keep gaining it forever until you die”.
But then again, consider this:
Most adults will gain half a kilo this year – and every year. Here’s how to stop “weight creep”
That’s more weight gain than one gets on sertraline, the most weight-gain-inducing antidepressant tested!
What about over longer-term use?
Here’s a more recent study (December 2024) that looked at antidepressant use over 6 years, and found an average 2% weight gain over those 6 years, but it didn’t break it down by antidepressant type, sadly:
…which seems like quite a wasted opportunity, since some of the medications considered are very different, working on completely different systems (for example, SSRIs vs NDRIs, working on serotonin or norepinephrine+dopamine, respectively—see our Neurotransmitter Cheatsheet for more about those) and having often quite different side effects. Nevertheless, the study (despite collecting this information) didn’t then tabulate the data, and instead considered them all to be the same factor, “antidepressants”.
What this study did do that was useful was included a control group not on antidepressants so we know that on average:
- never-users of antidepressants gained an average of 1% of their bodyweight over those 6 years
- users-and-desisters of antidepressants gained an average of 1.8% of their bodyweight over those 6 years*
- continuing users of antidepressants gained an average of 2% of their bodyweight over those 6 years
*for this group, weight gain was a commonly cited reason for stopping taking the antidepressants in question
Writer’s anecdote: I’ve been on mirtazapine (a presynaptic alpha2-adrenoreceptor antagonist which increases central noradrenergic and serotonergic neurotransmission) for some years and can only say that I wish I’d been on it decades previously. I requested mirtazapine specifically, because I’m me and I know my stuff and considered it would most likely be by far the best fit for me out of the options available. Starting at a low dose, the only meaningful side effect was mild sedation (expected, and associated only with low-dose use); increasing after a couple of weeks to a moderate dose, that side effect disappeared and now the only remaining side effect is a slight dryness of the mouth, which is fine, as it ensures I remember to stay hydrated 🙂 anyway, my weight hasn’t changed (beyond very small temporary fluctuations) in the time I’ve been on mirtazapine. Disclaimer: the plural of anecdote is not data, and I can only speak for my own experience, and am not making any particular recommendation here. Your personal physiology will be different from mine, and may respond well or badly to any given treatment according to your own physiology.
Further considerations
This is touched on in the “Discussion” section of the latter paper (so do check that out if you want all the details, more than we can reasonably put here), but there are other factors to consider, for example:
- whether people were underweight/healthy weight/overweight at baseline (sometimes, a weight gain can be a good thing, recovering from an illness, and in the case of the illness that is depression, weight can swing either way)
- antidepressants changing eating and exercise habits (generally speaking: more likely to eat more and exercise more)
- body composition! How did they not cover this (neither paper did)?! Muscle weighs more than fat, and improvements in exercise can result in an increase in muscle and thus an increase in overall weight.
As researchers like to say, “this highlights the need for more high-quality studies to look into…” (and then the various things that went unexamined).
Want to know more?
Check out our previous main feature:
Antidepressants: Personalization Is Key!
Take care!
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Super Gut – by Dr. William Davis
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
You may be wondering: what sets this book apart from the other gut health books we’ve reviewed? For this one, mostly it’s depth.
This is the most scientifically dense book we’ve reviewed on gut health, so if you’re put off by that, this might not be one for you. However, you don’t need prior knowledge, as he does explain things as he goes. The advice in this book is not just the usual “gut health 101” stuff, either!
A particular strength of this book is that it looks at a wide variety of gut- and gut-related disorders, and ways certain readers may need to do different things than others, to address those problems on the path to good gut health.
The style, for all its hard science content, is quite sensationalist, and that may take some getting used to for non-Americans. However, it doesn’t affect the content!
Bottom line: if you just want simple basic advice, then probably best to skip this one. However, if you are sincerely serious about gut health (or just like reading this sort of thing because learning is satisfying), then this book is packed with relevant and detailed information.
Click here to check out Super Gut, and get to know and improve yours!
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Xylitol vs Erythritol – Which is Healthier?
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Our Verdict
When comparing xylitol to erythritol, we picked the xylitol.
Why?
They’re both sugar alcohols, which so far as the body is concerned are neither sugars nor alcohols in the way those words are commonly understood; it’s just a chemical term. The sugars aren’t processed as such by the body and are passed as dietary fiber, and nor is there any intoxicating effect as one might expect from an alcohol.
In terms of macronutrients, while technically they both have carbs, for all functional purposes they don’t and just have a little fiber.
In terms of micronutrients, they don’t have any.
The one thing that sets them apart is their respective safety profiles. Xylitol is prothrombotic and associated with major adverse cardiac events (CI=95, adjusted hazard ratio=1.57, range=1.12-2.21), while erythritol is also prothrombotic and more strongly associated with major adverse cardiac events (CI=95, adjusted hazard ratio=2.21, range=1.20-4.07).
So, xylitol is bad and erythritol is worse, which means the relatively “healthier” is xylitol. We don’t recommend either, though.
Studies for both:
- Xylitol is prothrombotic and associated with cardiovascular risk
- The artificial sweetener erythritol and cardiovascular event risk
Links for the specific products we compared, in case our assessment hasn’t put you off them:
Want to learn more?
You might like to read:
- The WHO’s New View On Sugar-Free Sweeteners ← the WHO’s advice is “don’t”
- Stevia vs Acesulfame Potassium – Which is Healthier? ← stevia’s pretty much the healthiest artificial sweetener around, though, if you’re going to use one
- The Fascinating Truth About Aspartame, Cancer, & Neurotoxicity ← under the cold light of science, aspartame isn’t actually as bad as it was painted a few decades ago, mostly by a viral hoax letter. Per the WHO’s advice, it’s still good to avoid sweeteners in general, however.
Take care!
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How To Ease Neck Pain At Home
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Dr. Bang is offering exercises to alleviate neck pain, which pain can be a real… Well, if only there were a good phrase for expressing how troublesome pain in that part of the body can be.
To be clear, he’s a doctor of chiropractic, not a medical doctor, but his advice has clearly been helping people alleviate pain, so without further ado, he advises the following things:
- Taking the head and neck slowly and carefully through the full range of motion available
- Contracting the neck muscles while repeating the above exercise, three times each way
- Backing off a little if it hurts at any point, but noting where the limits lie
- Repeating again the range of motion exercise, this time adding gentle resistance
- Holding each end of this for twenty seconds before releasing and doing the other side, three times each way
- Finally, stabilizing the head centrally and pushing into one’s hands, as an isometric strengthening exercise
He demonstrates each part clearly in this short (5:58) video:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to know more about chiropractic?
You might like our previous main feature:
Is Chiropractic All It’s Cracked Up To Be?
Take care!
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Cannabis Myths vs Reality
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Cannabis Myths vs Reality
We asked you for your (health-related) opinion on cannabis use—specifically, the kind with psychoactive THC, not just CBD. We got the above-pictured, below-described, spread of responses:
- A little over a third of you voted for “It’s a great way to relax, without most of the dangers of alcohol”.
- A little under a third of you voted for “It may have some medical uses, but recreational use is best avoided”.
- About a quarter of you voted for “The negative health effects outweigh the possible benefits”
- Three of you voted for “It is the gateway to a life of drug-induced stupor and potentially worse”
So, what does the science say?
A quick legal note first: we’re a health science publication, and are writing from that perspective. We do not know your location, much less your local laws and regulations, and so cannot comment on such. Please check your own local laws and regulations in that regard.
Cannabis use can cause serious health problems: True or False?
True. Whether the risks outweigh the benefits is a personal and subjective matter (for example, a person using it to mitigate the pain of late stage cancer is probably unconcerned with many other potential risks), but what’s objectively true is that it can cause serious health problems.
One subscriber who voted for “The negative health effects outweigh the possible benefits” wrote:
❝At a bare minimum, you are ingesting SMOKE into your lungs!! Everyone SEEMS TO BE against smoking cigarettes, but cannabis smoking is OK?? Lung cancer comes in many forms.❞
Of course, that is assuming smoking cannabis, and not consuming it as an edible. But, what does the science say on smoking it, and lung cancer?
There’s a lot less research about this when it comes to cannabis, compared to tobacco. But, there is some:
❝Results from our pooled analyses provide little evidence for an increased risk of lung cancer among habitual or long-term cannabis smokers, although the possibility of potential adverse effect for heavy consumption cannot be excluded.❞
Read: Cannabis smoking and lung cancer risk: Pooled analysis in the International Lung Cancer Consortium
Another study agreed there appears to be no association with lung cancer, but that there are other lung diseases to consider, such as bronchitis and COPD:
❝Smoking cannabis is associated with symptoms of chronic bronchitis, and there may be a modest association with the development of chronic obstructive pulmonary disease. Current evidence does not suggest an association with lung cancer.❞
Read: Cannabis Use, Lung Cancer, and Related Issues
Cannabis edibles are much safer than smoking cannabis: True or False?
Broadly True, with an important caveat.
One subscriber who selected “It may have some medical uses, but recreational use is best avoided”, wrote:
❝I’ve been taking cannabis gummies for fibromyalgia. I don’t know if they’re helping but they’re not doing any harm. You cannot overdose you don’t become addicted.❞
Firstly, of course consuming edibles (rather than inhaling cannabis) eliminates the smoke-related risk factors we discussed above. However, other risks remain, including the much greater ease of accidentally overdosing.
❝Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected.❞
Note: that “more frequent” for inhaled cannabis, is because more people inhale it than eat it. If we adjust the numbers to control for how much less often people eat it, suddenly we see that the numbers of hospital admissions are disproportionately high for edibles, compared to inhaled cannabis.
Or, as the study author put it:
❝There are more adverse drug events associated on a milligram per milligram basis of THC when it comes in form of edibles versus an inhaled cannabis. If 1,000 people smoked pot and 1,000 people at the same dose in an edible, then more people would have more adverse drug events from edible cannabis.❞
See the numbers: Acute Illness Associated With Cannabis Use, by Route of Exposure
Why does this happen?
- It’s often because edibles take longer to take effect, so someone thinks “this isn’t very strong” and has more.
- It’s also sometimes because someone errantly eats someone else’s edibles, not realising what they are.
- It’s sometimes a combination of the above problems: a person who is now high, may simply forget and/or make a bad decision when it comes to eating more.
On the other hand, that doesn’t mean inhaling it is necessarily safer. As well as the pulmonary issues we discussed previously, inhaling cannabis has a higher risk of cannabinoid hyperemesis syndrome (and the resultant cyclic vomiting that’s difficult to treat).
You can read about this fascinating condition that’s sometimes informally called “scromiting”, a portmanteau of screaming and vomiting:
Cannabinoid Hyperemesis Syndrome
You can’t get addicted to cannabis: True or False?
False. However, it is fair to say that the likelihood of developing a substance abuse disorder is lower than for alcohol, and much lower than for nicotine.
See: Prevalence of Marijuana Use Disorders in the United States Between 2001–2002 and 2012–2013
If you prefer just the stats without the science, here’s the CDC’s rendering of that:
Addiction (Marijuana or Cannabis Use Disorder)
However, there is an interesting complicating factor, which is age. One is 4–7 times more likely to develop a substance abuse disorder, if one starts use as an adolescent, rather than later in life:
Cannabis is the gateway to use of more dangerous drugs: True or False?
False, generally speaking. Of course, for any population there will be some outliers, but there appears to be no meaningful causal relation between cannabis use and other substance use:
Interestingly, the strongest association (where any existed at all) was between cannabis use and opioid use. However, rather than this being a matter of cannabis use being a gateway to opioid use, it seems more likely that this is a matter of people looking to both for the same purpose: pain relief.
As a result, growing accessibility of cannabis may actually reduce opioid problems:
- Cannabis as a Gateway Drug for Opioid Use Disorder
- Association between medical cannabis laws and opioid overdose mortality has reversed over time
Some final words…
Cannabis is a complex drug with complex mechanisms and complex health considerations, and research is mostly quite young, due to its historic illegality seriously cramping science by reducing sample sizes to negligible. Simply put, there’s a lot we still don’t know.
Also, we covered some important topics today, but there were others we didn’t have time to cover, such as the other potential psychological benefits—and risks. Likely we’ll revisit those another day.
Lastly, while we’ve covered a bunch of risks today, those of you who said it has fewer and lesser risks than alcohol are quite right—the only reason we couldn’t focus on that more, is because to talk about all the risks of alcohol would make this feature many times longer!
Meanwhile, whether you partake or not, stay safe and stay well.
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Cashews vs Peanuts – Which is Healthier?
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Our Verdict
When comparing cashews to peanuts, we picked the peanuts.
Why?
Another one for “that which is more expensive is not necessarily the healthier”! Although, certainly both are good:
In terms of macros, cashews have about 2x the carbs while peanuts have a little more (healthy!) fat and more than 2x the fiber, meaning that peanuts also enjoy the lower glycemic index. All in all, a fair win for peanuts here.
When it comes to vitamins, cashews have more of vitamins B6 and K, while peanuts have a lot more of vitamins B1, B2, B3, B5, B7, B9, and E. Another easy win for peanuts.
In the category of minerals; cashews have more copper, iron, magnesium, phosphorus, and selenium, while peanuts have more calcium, manganese, and potassium. A win for cashews, this time.
Adding up the sections makes for an overall win for peanuts, but (assuming you are not allergic) enjoy either or both! In fact, enjoying both is best; diversity is good.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts!
Take care!
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Healing Your Gut: Anastasia’s Journey and Tips
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Anastasia Gurova shares her inspiring journey from chronic gut issues to vibrant health.
A Personal Journey to Gut Health
In the below video, Anastasia shares her long struggle with gut problems, including SIBO, IBS, and gastritis. She talks about ending up in the hospital with severe bloating, only to find that a range of medical approaches didn’t provide her with any lasting relief. This led her to explore the importance of the microbiome and its crucial role in gut health, which is what we’ll be focusing on in this overview.
Key Insights and Tips
The most valuable parts of Anastasia’s story for 10almonds readers are, in our opinion, the solutions she discovered to her gut issues. You’ll have to watch her video to discover all of them, but here are some of our favorites:
- Reintroduce Whole Grains and Legumes: Despite the popularity of grain-free diets, Anastasia found significant improvements in her gut health by adding whole grains like quinoa, oats, and buckwheat back into her diet. These foods provide essential fibers that feed beneficial gut bacteria.
- Soaking and Fermenting Foods: To make grains and legumes more digestible, Anastasia recommends soaking them overnight. This is similar to the common technique people use on oats. She also includes fermented foods like sauerkraut, kimchi, and yogurt in her diet, which introduce beneficial bacteria to the gut.
- Resistant Starches: Foods like cooked and cooled rice, potatoes, and green bananas contain resistant starches that promote healthy gut bacteria. Anastasia emphasizes incorporating these into meals to support gut health.
- Mindful Eating: Anastasia found that taking time to chew food thoroughly and savor each bite helped improve her digestion. She avoids distractions like TV while eating and pays attention to the textures and flavors of her meals.
- Avoid Overly Restrictive Diets: Anastasia warns against overly restrictive diets like keto and strict SIBO diets that cut out all carbs and fiber. These can worsen gut health by starving beneficial bacteria.
That’s Only The Beginning
Anastasia’s video goes far beyond what we’ve covered in this short introduction; she provides a detailed look at the steps she took, from dietary changes to lifestyle adjustments, and offers tips that anyone can apply. Plus, she explains the science behind these changes, which, of course, we love.
Enjoy the video! (It would be remiss for us to not bring up our general intro to gut health, or our more specific article on the gut-brain connection)
Good luck on your gut-health journey!
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