抑郁药物的困局: Happier But Heavier?

Antidepressants can make a big difference to quality of life, but they have also been linked to weight gain in some people. But there are ways to limit the extra kilos.

Antidepressants are powerful medications for treating people suffering from depression. The first thing to stress is that these drugs can save lives, and for most people they are effective in restoring a good quality of life.

Unfortunately, like most drugs, antidepressants have side-effects and about a quarter of people using them report unwanted weight gain. That’s an important statistic to remember if you’re considering medication for depression because it means that 75 per cent of people on antidepressants don’t have problems with weight gain.

There are many types of antidepressant medications and your doctor will work with you to identify one that best controls the symptoms of depression while causing the least side effects. Of course, controlling depression is the primary concern, so for some people taking medications, some weight gain may need to be accepted, but that doesn’t mean there aren’t steps that can be taken to minimise it or eliminate it completely.

Why do antidepressants cause weight gain?

Depression can cause a loss of appetite and so, if an antidepressant medication is successful in combating depressive symptoms, some people will find themselves regaining their appetite. Not surprisingly, this renewed enthusiasm can sometimes lead to overeating and weight gain in some patients.

These medications can stimulate appetite and enhance the desire for kilojoule-laden sugary and starchy foods. They can also reduce metabolic rate even while exercising, and this is a recipe for weight gain because ‘energy in’ exceeds ‘energy out’.

Step one: consult with your doctor

Talk about your concerns regarding any weight gain with your doctor. It may be that there is an alternative medication available that is similarly effective for your symptoms, but won’t cause weight gain.  Alternatively, your doctor might suggest reducing the dose of the medication you are taking. Antidepressants are powerful medications, so remember any decision to reduce dosage or change medications must be made with your doctor.

Step two: eat smarter

If appetite is increased then making smart food choices should help with better weight control. Avoid sweets and fatty snack foods wherever possible and focus instead on consuming vegetables and fruits. Fibre-rich foods like whole grains and beans will help you feel satisfied for longer because the fibre digests slowly and leaves you feeling satisfied for longer. All these foods are healthy and filling without all the empty kilojoules from fatty or sugary foods.

Make sure that you eat breakfast and avoid skipping meals. Eating several smaller meals over the course of the day will also help keep metabolic rate higher so that you burn more kilojoules.

Step three: pay attention to calcium and vitamin D

There is evidence that getting sufficient calcium and vitamin D in the diet helps with weight control and promotes better mental health. Low-fat dairy products (like low-fat milk and yoghurt) are good sources of calcium, while 15 minutes a day exposed to sun will boost vitamin D levels. If these are not suitable for you, calcium and vitamin D supplements may be helpful. Discuss this option with your doctor to see whether supplements are recommended or not.

Step four: build muscle

Strength or resistance training (i.e. lifting weights) helps build lean muscle mass which can also boost metabolism. If your metabolic rate has become sluggish because of the medication then resistance training can help to improve overall metabolism by increasing lean muscle that burns more kilojoules. Again, if you haven’t exercised for a long time or you have any medical conditions that may make strength training unsuitable, check in with your doctor first.

Step five: exercise more where possible

Once your doctor gives you the ‘all clear’ to exercise, regular physical activity should be part of your life. This is important for everyone, but it’s particularly useful for people on medications like antidepressants. Exercise offers a double benefit – not only does it help burn kilojoules and control your weight, it can also help by boosting your mood.

Getting back into exercise can be difficult when you’ve been battling with depression and staying motivated can be tough, but remember it’s so good for you and you can start small (even a ten-minute walk can help) and build as you get fitter. If you’re having trouble, consider asking someone to act as your exercise buddy, signing up for a class or walking group, or booking some time with a personal trainer. It really is worth it.

If you’re exercising fairly regularly and still losing the battle with weight control, despite paying attention to diet, then you may need to change the way you’re exercising. You can mix and match with different exercises to enhance variety. This might allow and encourage you to do more exercise. This could mean that you exercise for longer in each session or do more exercise sessions per week.

Exercise intensity plays an important role in boosting metabolism over the longer term. If you’re just going through the motions of exercising, then it may be time to step up the pace of your walking or jogging, or to start introducing hill climbing as part of your walk or run. If you’re able to increase the intensity of the exercise in each session then you’ll be burning more kilojoules per workout and increasing your fitness over time.

Putting weight gain in context

Don’t despair over gaining a few extra kilos if your mental health has been improved significantly by the medication. Some people lose weight when they're depressed, so gaining weight on antidepressants can actually be a welcome sign.

The primary goal is to combat the depression and to be able to think clearly and optimistically so that you can prepare a long-term strategy for facing life’s challenges. Part of that long-term strategy might be to achieve a healthy body weight and to improve overall health and fitness. This can be approached in a sensible and realistic way so that goals such as weight loss and body weight control can be achieved over the longer term.

work out n eat right n sleep early.....