For reasons that can only be speculated on, depression has been steadily increasing in the United States over the past few decades. According to the National Institutes of Health (NIH), approximately 21 million adults and four million adolescents were diagnosed with major depression or had at least one major depressive episode. To treat a major depressive disorder, doctors often prescribe antidepressant medications like Lexapro (escitalopram). While these medications do have a track record of success in easing the effects of depression, they also are known to have numerous side effects; one of those possible side effects is weight gain.
When people use the term “clinical depression,” they’re usually referring to the condition known as major depressive disorder (MDD). MDD is a mental disorder that involves symptoms like low self-esteem, feeling down, or a loss of interest in activities that are normally enjoyable. To be characterized as a major depressive disorder these symptoms must be present for at least two weeks, though in reality they may have been going on for much longer. Anyone can develop MDD, but it is twice as likely to affect females compared to males.
Depression and other mental health problems are sometimes hard to diagnose since there aren’t any lab tests that can provide confirmation. Instead, psychiatrists and psychologists must evaluate a patient based on their reported experiences and a mental status examination, which is an assessment of the person’s current mental state and the likelihood of self-harm or suicide. Because of the specialized skills needed to diagnose and treat depression, it often goes undiagnosed, especially in rural areas.
Nobody knows what causes depression, though there is evidence that it is linked to some genetic factors. Most research seems to indicate that the underlying mechanism of depression is related to the balance and functioning of certain neurotransmitters and nerve cells in the brain. There are also clear indications that stressful events in the course of life may play a role as well. When the body experiences stress, an array of neurotransmitters and hormones spring into action and cause a variety of physiological changes; in cases of long-term or chronic stress, the brain may even change permanently.
Although much has been learned about the brain and depression over decades of research, there is still much that doctors don’t know. Because of this, the standard treatments are mainly strategies for managing the symptoms of depression and increasing quality of life. One of the most common types of treatment is psychotherapy, an approach that involves managing the emotional effects through discussion and self-reflection. In rare cases, usually when other methods have failed, electroconvulsive therapy (ECT) can be used to target specific areas of the brain with a small electrical current.
Another common treatment—often along with psychotherapy—is medication. Though different kinds of antidepressant medications work in different ways and have different effects, they all generally function by manipulating neurotransmitter levels. Below are the main types of antidepressant and examples of brand names:
As noted above, Lexapro is an antidepressant in the SSRI class, and it increases the amount of serotonin available in the brain by inhibiting its reabsorption by neurons. Having more serotonin available means the brain is better able to regulate mood, the ability to sleep, and symptoms associated with depression and anxiety. Like most other antidepressants, Lexapro seems to work well for some and less so for others. It also has some common side effects that should be taken into account:
Both weight gain and weight loss are common with depression because of the tendency to turn toward or away from food depending on one’s emotional state. In antidepressants like Lexapro, however, the medication itself may include weight gain or weight loss as a side effect; these effects may also differ from person to person. In one study, for example, 41% of patients on Lexapro gained weight. There is additional evidence that any weight gain is a higher likelihood if the patient is a smoker, lives a sedentary lifestyle, or has a diet that is high in carbohydrates and processed foods.
The primary mechanism for affecting body weight changes is the impact of Lexapro on serotonin, though the nature of the effect seems to depend on length of treatment. Over the short term, the additional serotonin can reduce impulsiveness and increase satiety; the combined effects can lead to weight loss because the patient won’t eat as much. Long-term use, on the other hand, seems to cause the downregulation of serotonin receptors in some people; this can then lead to higher food cravings, especially for carbohydrate-rich foods. There is also some evidence that Lexapro may indirectly cause the body’s metabolism to use calories less efficiently, but more research is needed.
With any side effects related to antidepressants, it can be tempting to stop taking the meds in an effort to reverse the effects. With Lexapro and others, though, this may not work; long-term studies show that weight fluctuations may last for years even after stopping the medication. In other words, stopping the medication won’t necessarily lead to weight loss; moreover, stopping the medication may bring back depression and feelings that lead back to overeating and even greater weight gain.
Depression is a complex condition, and the treatment of it can have many different effects on the body. Even if an antidepressant leads to weight gain, the positive impact on mood can help a patient take measures to limit gain or actually lose weight. This can be done first and foremost by sticking to a healthy, balanced diet that focuses on nutrient-rich foods that increase feelings of fullness. The other key component of maintaining a health weight (as well as overall health and wellbeing) is regular physical activity and exercise.
The reasons why people gain weight are complex and often different from person to person. And while dieting and exercise are important parts of achieving the kind of calorie deficit that leads to weight loss, they often aren’t enough alone to make a lasting difference. At True You Weight Loss, we offer alternative weight loss solutions that are designed to help people make changes that will lead to long-term results. If you’d like to learn more about the benefits of non-surgical weight loss procedures, please contact us today to request a consultation. Freedom is waiting!
Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.
