By Dr. David Woo - May 16, 2023

Why does depression tend to lead to weight gain or loss, how are weight changes linked to depression, and how can weight management help your depression treatment?

Why Can Depression Make Your Weight Change?

When you search for the symptoms of depression, you’ll likely see both weight loss and weight gain. So, which is it? The answer is: it depends on the person. While some people with depression will gain weight, others will lose weight. Below we’ll explore the role of depression in weight changes.

How Can Depression Affect Your Weight?

Researchers know that depression can lead to weight gain and that weight gain can also contribute to depression. 

The Coronary Artery Risk Development in Young Adults Study (CARDIA) revealed that patients with depressive symptoms are more likely to experience an increase in BMI (body mass index) and waist circumference over subsequent years compared to people who do not have depressive symptoms (1).

Weight gain can happen when a person is depressed because:

• They lose interest in activities and are less physically active
• They tend to eat a diet higher in fat due to poor food choices
• Certain depression treatments, such as antidepressants, may cause weight gain
• Researchers and doctors also know that weight gain increases the risk of developing depression. A study published in 2010 found that obese patients were 55% more likely to develop depression compared to patients who were not obese (2).

Do Antidepressants Have Any Effect On Weight?

Certain medications for depression are commonly known to affect body weight more than others. Below is a list of medications that have been found most likely to cause weight changes, as well as those that may cause weight loss and some that appear less likely to affect weight (3,4,5,6). However, it is important to note that side effects may vary between individuals and be affected by external factors  such as lifestyle, genetic predisposition, and co-morbidities.

Antidepressants that may cause weight gain

• Mirtazapine (Remeron)
• Amitriptyline (Elavil)
• Paroxetine (Paxil, Brisdelle, Pexeva)
• Escitalopram (Lexapro)
• Sertraline (Zoloft)
• Duloxetine (Cymbalta)
• Citalopram (Celexa)
• Fluoxetine (Prozac)

Antidepressants that may cause weight loss

• Bupropion (Aplenzin, Forfivo, Wellbutrin)
• Fluoxetine (Prozac)
• Duloxetine (Cymbalta)

Weight-neutral antidepressants (less likely to affect weight)

• Venlafaxine (Effexor) 
• Desvenlafaxine (Pristiq)
• Vortioxetine (Trintellix)

Of the above medications associated with weight loss, Bupropion is the most linked to weight loss. Fluoxetine has been connected to weight loss in some cases but may then lead to weight gain in the long term. The link between Duloxetine and weight loss is inconsistent (6).

Not all patients who take antidepressants will gain weight. However, weight gain is a possible side effect of certain antidepressants. For patients who are looking for an alternative to antidepressants, TMS (transcranial magnetic stimulation) is a medication-free, noninvasive procedure that provides relief from depression symptoms without the side effects associated with antidepressants.  

Depression And Weight Gain

If you have been suffering from depression and also experiencing weight gain, you aren’t alone. Doctors have known for years that depression and weight gain are linked and may even have a bidirectional relationship–depression may cause weight gain, and weight gain may also trigger depression (7, 8). This can be especially significant for older adults, 10-15% of whom experience clinically relevant depressive symptoms. Depression is associated with an increased likelihood of developing a disability, as well as diabetes, cardiovascular disease (CVD), and cardiac mortality (9).

How Can Depression Cause Weight Gain?

This relationship between depression and weight gain may be due to the chemical changes in the brain associated with depression as well as the negative behavioral patterns that can lead to overeating or lack of sleep.

Loss of motivation & slowing down

One common symptom of depression is anhedonia, a loss of interest in activities that you would normally find pleasurable. This can include healthy activities such as shopping for and cooking healthy meals, participating in sports, or doing exercise. The loss of motivation can lead to the abandoning of these positive activities. The corresponding ‘slowing down’ of life can lead to weight gain due to a lack of physical activity and the choosing of less healthy low-effort options for food and entertainment.

Elevated levels of cortisol

Many people with depression and obese people are noted to have higher levels of cortisol, a chemical messenger that plays a crucial role in your body’s stress response. Extended periods of high cortisol levels can lead to increased appetite and overeating, and thus weight gain.

Inflammation

Just as with cortisol, researchers have found high levels of inflammatory markers among people with depression and people with obesity. Inflammation is also part of the body’s stress response, usually as a reaction to injury, and causes swelling, soreness, and redness in affected areas. Inflammatory markers, such as the C-reactive protein (CRP), are associated with weight gain, and inflammation can block your feeling of “fullness” after a meal, leading to overeating.

Emotional eating & carb craving

Emotional eating is when we turn to food consumption in order to alleviate negative emotional states, commonly referred to as “comfort eating”, or even “eating your feelings.” Food high in carbohydrates, especially sweet snacks such as cookies or candy, is commonly reached for when we crave a “pick-me-up” during times of stress or weariness. Carb cravings have been linked to low serotonin levels, which are typically associated with depression. Because of this serotonin deficiency and low mood, people with depression may experience more frequent and stronger carb cravings and consume to excess. According to the literature on the subject, people who engage in emotional eating often push back against dieting, holding on to a “need to be bad” and indulging in a cycle of binging and shame, but there are techniques to break the pattern (10).

Social changes

The effects of depression can be devasting to one’s social life. Typical symptoms include a withdrawal from activities with family or friends, poor motivation and performance at work or school, and an engagement in self-destructive behaviors such as substance abuse and binge eating. Our social support network can play a crucial role in our physical and mental health–for example, by pointing out unhealthy lifestyle changes and offering to help. If we are isolated from others, we may be less likely to bother taking care of ourselves. Weight gain may also trigger body image insecurities that, in a vicious circle, can cause us to further avoid social contact.

Lifestyle changes & poor sleep

The abovementioned symptoms of loss of motivation, social isolation, and the binging of food, alcohol, or other substances can contribute to a disrupted sleep pattern and dysregulated cortisol levels. This, in turn, can leave us craving calorie-rich food to pick up our energy levels, especially if it is quick and easy fast food or snacks.

Depression And Weight Loss

Depression doesn’t always lead to weight gain. People with depression can also experience weight loss. Researchers have found a correlation between depression and weight loss in older adults, and the same dysregulation of eating, sleeping, and lifestyle habits can cause some individuals to lose weight rather than gain it (11). Depression is also commonly seen among patients with other health conditions, like anorexia and other eating disorders (12).

How Can Depression Cause Weight Loss?

When we are depressed, the feelings of pleasure and satisfaction we get from eating can be diminished or even nonexistent. In some cases, this can lead to overeating as we seek out more treats in an attempt to chase the pleasure of eating, but in other cases, it can simply result in eating less food or less nutritional food.

Depression-caused loss of appetite

People with depression may experience a lack of interest in shopping for food, preparing meals, and eating. Depression diminishes our capacity to feel pleasure, but it can also affect our sense of taste–studies have found that people with depression have a loss of taste, making food even less appealing than it used to be (13).

Mood changes

The intensity of the mood swings that come with depression can also overwhelm our feelings of hunger. With overwhelming feelings of sadness, hopelessness, or frustration, we may just not be able to think about food, let alone adhere to regular healthy meals.

Change in everyday habits

Depressive symptoms such as intense low moods, social withdrawal, lack of sleep, and a loss of interest in hobbies and activities can make it difficult to maintain a routine and can lead to skipping meals or choosing low-prep fast food. When patients with depression skip meals or eat meals that are high in sugar or grease, this can lead to malnourishment and weight loss, which can also contribute to depression (14). 

Fatigue & low energy levels

Depression can leave us feeling low and tired all the time. Grocery shopping, cooking, and even getting out of bed might seem like just too much effort, leading us to neglect our nutritional needs.

Anxiety & stress

Anxiety is a common co-occurring mood disorder in individuals with depression, affecting almost half of depression patients in what is termed as anxious depression. People with intense anxiety or stress experience reduced appetite and dysregulated cortisol levels. They may also burn more calories due to nervous movement and fidgeting.

The Link Between Weight Changes And Depression

In some cases, the weight change itself can be a triggering event for depressive symptoms. This is true for weight loss as well as weight gain. Either can trigger the onset of depression or make existing symptoms worse.

Can Weight Gain Make You Depressed?

Yes. The negative stigma associated with being overweight, either from one’s social peers or from internal self-image struggles, can bring about depressive symptoms such as sadness, social isolation, and a low sense of self-worth. Because being depressed can then cause further weight gain, this can lead to a vicious cycle that can only be overcome with proper treatment and self-discipline.

Can Weight Loss Make You Depressed?

Yes. A sudden drop in weight can bring about a lack of nutrients or chemical imbalance that can affect our body’s balance of nutrition, rest, and activity which is critical in regulating our mood, health, and well-being.

Depression Treatment And Weight Management

Depression treatment often involves combining multiple treatments, like talk therapy and antidepressants, as well as lifestyle changes, like increasing exercise and altering one’s diet. Lifestyle changes specifically, such as walking and incorporating more fruits and vegetables into one’s diet, can help patients return to their normal weight.

Weight Management Tips For People With Depression

Make a healthy lifestyle your goal

Whether depression is a factor or not, there is no fast track to a healthy weight. A healthy lifestyle, including regular sleep, healthy meals, and physical activity, should be your long-term target. But that doesn’t mean that it can’t be broken down into smaller short-term steps.

Balance your diet

A reliance on high-calorie foods with low nutritional value, such as fried or sugary snacks, can leave you feeling unsatisfied when eating or hurt one’s self-image. Try to maintain a balanced diet, with plenty of fruits and vegetables, as a key part of your weight management plan. To

Get more exercise

Low energy levels and a lack of motivation usually result in reduced physical activity and weight gain. It’s important to stay active and exercise regularly, starting small and building up–while it can be a challenge to start, you may also find that the exercise improves your mood. For people with unintentional weight loss, the calories burned with exercise can also boost your appetite.

Take it slow

Depression can make it harder to focus on a long-term goal, and while lifestyle changes are difficult, they should not seem impossible. Very sudden and dramatic fluctuations in weight are also not healthy or sustainable in the long term. Break down your health goals into smaller, achievable steps to avoid being overwhelmed, e.g., cutting down on sugary snacks one week, carbs the next week, and starting a new exercise routine the week after.

Consult with a registered dietitian

A professional dietitian can help you set realistic targets and advise on the best foods for your weight goals. This is especially true if your weight loss or gain has been drastic or persistent.

Ask your doctor if your medications might be interfering with your weight management goals

Because so many medications for depression are associated with weight changes, you should consult with your doctor about possible side effects and explore alternative treatment options if the side effects from your medications are intolerable or making things worse. TMS is FDA-approved as a non-pharmaceutical treatment for depression in cases where medications have failed and may be a better choice for patients experiencing undesirable side effects from antidepressant meds. Madison Avenue TMS & Psychiatry offers talk therapy and TMS for depression, anxiety, and other conditions. Contact us online or call (212) 731-2033 to make an appointment for consultation or treatment.

Resources:

1. Needham BL, Epel ES, Adler NE, and Kiefe C. Trajectories of change in obesity and symptoms of depression: the CARDIA study. Am J Public Health. 2010;100(6):1040-1046. Link. Accessed August 1, 2023.
2. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH, Zitman FG. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010 Mar;67(3):220-229. Link. Accessed August 1, 2023.
3. Serretti A, Mandelli L. Antidepressants and body weight: A comprehensive review and meta-analysis. Journal of Clinical Psychiatry. 2010; 71(10): 1259-1272. Link. Accessed August 1, 2023.
4. Uguz F, Sahingoz M, Gungor B, Aksoy F, Askin R. Weight gain and associated factors in patients using newer antidepressant drugs. Gen Hosp Psychiatry. 2015; 37 (1): 46-48. Link. Accessed August 1, 2023.
5. Salvi V, Mencacci C, Barones-Adesi F. H1-histamine receptor affinity predicts weight gain with antidepressants. European Neuropsychopharmacology. 2016; 26(10): 1673-1677. Link. Accessed May 12, 2022.
6. Antidepressants that Cause Weight Loss. Khealth. Published August 18, 2021. Link. Accessed August 1, 2023.
7. Faith, M. S., Butryn, M., Wadden, T. A., Fabricatore, A., Nguyen, A. M., & Heymsfield, S. B. Evidence for prospective associations among depression and obesity in population-based studies. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 2011;12(5), e438–e453. Link. Accessed August 1, 2023.
8. Blasco, B. V., García-Jiménez, J., Bodoano, I., & Gutiérrez-Rojas, L. Obesity and depression: Its prevalence and influence as a prognostic factor: A systematic review. Psychiatry Investigation. 2020;17(8), 715–724. Link. Accessed August 1, 2023.
9. Vogelzangs, N., Kritchevsky, S. B., Beekman, A. T., Newman, A. B., Satterfield, S., Simonsick, E. M., Yaffe, K., Harris, T. B., & Penninx, B. W. Depressive symptoms and change in abdominal obesity in older persons. Archives of General Psychiatry. 2008; 65(12), 1386–1393. Link. Accessed August 1, 2023.
10. Farkas, H. (2019). 8 Keys to End Emotional Eating. New York, NY: W.W. Norton & Company, Inc. Link. Accessed August 1, 2023.
11. Stajkovic, S., Aitken, E. M., Holroyd-Leduc, J. Unintentional weight loss in older adults. CMAJ Mar 2011; 183 (4) 443-449. Link. Accessed August 1, 2023.
12. Understanding the Facts: Eating Disorders. Anxiety and Depression Association of America. Publication Date Unavailable. Link. Accessed August 1, 2023.
13. Hur, K., Choi, J. S., Zheng, M., Shen, J., & Wrobel, B. Association of alterations in smell and taste with depression in older adults. Laryngoscope Investigative Otolaryngology. 2018;3(2), 94-99. Link. Accessed August 1, 2023.
14. Rao TS, Asha MR, Ramesh BN, Rao KS. Understanding nutrition, depression, and mental illnesses. Indian J Psychiatry. 2008;50(2):77-82. Link. Accessed August 1, 2023.

Dr. David Woo

Dr. David Woo is the owner and head clinical psychiatrist at Madison Avenue TMS and Therapy in New York City. Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.

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