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Substantial weight gain is a common side effect of most antidepressant medication, and for many people, the weight is lost once the medication is no longer being taken. However, one antidepressant, bupropion (also known as Wellbutrin) seems to have the opposite effect. Weight is often lost while on the drug, and gained after it is stopped.
Bupropion is a medication prescribed for depression, but also as an aid to smoking cessation. One of its more attractive side effects, for those who appreciate being a few pounds lighter, is weight loss. Indeed, bupropion is now combined with another drug, naltrexone, and sold as the weight-loss drug Contrave.
Bupropion seems like a wonderful drug. Just imagine yourself feeling dumpy and depressed, having eaten your way through the winter doldrums or out of a difficult breakup. You try to diet, but your emotions keep you putting food in your mouth. The food is comforting, but there is a limit to the bags of salty chips or pints of ice cream you can eat without growing out of your clothes. At some point, you seek professional help for your depression and are started on bupropion. Within a short period of time, not only are you in a better emotional state, you have lost weight. You are thinner and happy. Perfection!
But at some point, theoretically, you and your therapist agree that it is time to stop the drug. You do this slowly, because there are some serious side effects if you stop abruptly. But you withdraw correctly and everything seems okay—until you notice you just gained 10 pounds. And then, maybe 20 pounds were suddenly added to your standard weight. Your amazing control over eating has vanished, along with your smaller jean size. How did this happen?
The reason is well-known to those who work on the chemistry of the brain. Bupropion increases the potency of two related brain chemicals: dopamine and norepinephrine, which have a stimulant effect on behavior. As a result, the sluggish, foggy brain, lethargic feelings of depression disappear, and more importantly? The sensation of hunger disappears, so it is very easy to eat less and even skip meals.
The problem is that when the antidepressant is no longer being taken, the withdrawal effects can be, well, depressing. Some people feel their mood becoming bleak again. They experience the fatigue we tend to associate with the aftermath of the flu, and no longer experience the bouncy, upbeat mood they had when they were on the drug. And for those who celebrated their almost magical ability to say no to fattening foods while on the drug, they now sadly find themselves saying yes.
This doesn’t mean that bupropion should not be taken. Every antidepressant drug seems to produce some side effects in most people, and at least patients don’t have to worry about gaining weight while they are taking this medication. But are patients being helped as they approach the end of their treatment with this drug to prevent them from gaining weight, and sometimes a considerable amount? I suspect not.
Consider this: If the patient — you perhaps — were taking bupropion as a weight-loss drug, and not as an antidepressant, you would also need help to improve your food choices, avoid overeating triggers, and stay engaged in an exercise regimen. Obviously this type of support is unlikely to be available from the therapist to whom you are going for your depression. He or she, after all, is not a weight-loss counselor or personal trainer, and you are not going to your therapist to lose weight.
But on the other hand, your therapist does know that you have a good chance of gaining weight when you stop the bupropion. This being established, doesn’t it make sense to offer you the support and advice of a weight-loss facility, or an individual to help you not gain weight during the transition from drug use to drug withdrawal? Indeed, the support should be started while the bupropion is still being taken, so that drug-assisted improvements in food intake and willingness to exercise are maintained when it has been discontinued.
But a note of realistic expectations must be inserted here. Even with the aid of weight-loss professionals, it may not be possible to prevent some weight gain when this stimulant anti-depressant is discontinued. You will feel hungrier and will need willpower to prevent yourself from gobbling everything in sight, at least for a short period. Willpower combined with eating small amounts of carbohydrates should work better than willpower alone. Eating carbohydrates will increase the activity of serotonin, the brain chemical that terminates eating. Serotonin won’t prevent you from wanting to eat, but it will make you feel full and satisfied before you have eaten too much.
Not all side effects from bupropion can be prevented. But certainly, it should be possible to limit its potential to cause weight gain when it is no longer being taken for depression. If that can be achieved, then it really will improve mood and weight. And that is a good track record for any drug.
