There’s still a lot we don’t know about antidepressants and what they do to the body and the brain, but some side effects are widely known, including a dip in sex drive, and perhaps most commonly, weight gain.
While each individual’s experience of a medication might be unique, psychiatrist and mental health educator Dr. Tracey Marks breaks down the scientifically accepted reasons why antidepressants, mood stabilizers and anti-psychotic can sometimes lead people to put on weight.
While usually associated with the immune system and allergic reactions in the body, Marks explains that histamine works differently in the brain. H1 receptors play a role in the sleep wake cycle, maintaining body temperature, regulating endocrine, pain, cognition, and appetite.
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Blocking H1 receptors affects the satiety center, i.e. the part of the brain that makes you feel full. “People can have terrible carbohydrate cravings on some of these medications,” says Marks. “But it’s not enough to say ‘just don’t overeat’, because when you tamper with your ability to feel full, you don’t see your eating as stuffing down extra food. You’re eating because you’re still hungry, and you don’t feel satisfied.”
Marks notes that another side effect of blocking H1 receptors is a decrease in thermogenesis, the process of creating heat in the body by burning fat. This leads to a longer term, slower increase in weight. “When you burn less fat, it accumulates,” she says. “The more fat you have, the higher your BMI.”
Some anti-psychotic medications also block the 5HT2C receptors, a type of serotonin receptor in the brain. “It’s been shown in mice that if you activate the 5HT2C receptors, they lose weight because they eat less, and if you block the receptor, they become obese,” says Marks.
Several studies into the side effects of drugs only report minimal weight gain, but Marks points out that these are often 12-week studies which neglect to account for the “creeping-up effect” of longer term weight gain due to histamine blocking.
There are things people can do to manage their weight when taking antidepressants. The simplest approach is to have a very strict diet and do plenty of intense exercise, such as resistance training, to build muscle and combat the slowed fat-burning process. Marks also lists several medication options which may help to mitigate weight gain — but these depend on your diagnosis and your current medication, and should be discussed with your doctor.
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