Depression, antidepressants, and body weight change.

The excessive weight gain observed during treatment of depression with antidepressant medications is caused in part, at least in some persons, by reductions in resting metabolic rate. Such problematic weight gain appears unrelated to clinical recovery, weight change during the depressive episode, prior weight, or other related factors. Preliminary results suggest that increased energy efficiency (of about 16-24%) during treatment with tricyclic antidepressants could promote weight gain even in the absence of a change in caloric intake. This is not a property of all antidepressants, as demonstrated by the increase in metabolic rate and associated weight loss observed during treatment with the monocyclic antidepressant compound fluvoxamine. Should these serotonergic compounds continue to be effective antidepressants, they may be better accepted by patients, and their use help avoid medication noncompliance. In considering energy balance and weight change, our focus has been drawn to altered metabolic rate. Continuing studies do not suggest an effect of antidepressants on appetite, particularly the presence of "carbohydrate craving," either during treatment or during a depressive episode. Certainly, a notable preference for highly palatable foods (rich in fats and carbohydrates) occurs during the depressive episode, but not during treatment. These foods cannot be labeled carbohydrates.