People are often worried that trying psychiatric medication will make them gain weight, and so, despite clearly suffering, they refuse to use some of the most effective and safe treatments available.

First, it’s important to note that several of these illnesses themselves cause weight gain. Depression can feature loss of interest and energy for exercising, as well as comfort/binge eating. Insomnia can cause weight gain too. [1] So, treating with medication can actually help patients lose weight.

As for the medications themselves, recent meta-analyses (large studies that combine the results of multiple studies) conclude that some medications are associated with weight gain, most of those commonly selected at this clinic are not, and some are even associated with weight loss. [2,3] There is at least one antidepressant that is even marketed separately as mild weight loss aid (bupropion-naltrexone).

The likelihood of weight change varies widely between medications. Before starting any medication, we can discuss its particular risk level, and lay out our plan to mitigate that risk. For higher-risk agents, that might include adding on other medications, possibly even preemptively, to counteract metabolic and appetite changes. For someone extremely concerned, we could even go as far as considering genetic testing before starting, since weight gain from certain antidepressants has been associated with testable liver enzyme variants. [4] At this clinic, weight gain concerns are taken seriously, because it is already hard enough coming in for treatment, and my priority is helping patients make healthy choices as seamlessly as possible.

The timescale of my approach has a three-part structure, with short-, medium-, and long-term interventions, so at every stage you feel some benefit, and these increase over time.

Short-term (in the moment): Coping skills, and some medications

In the heat of the moment, you’re upset, you want to react in an out of control way (fly off the handle, ditch your partner in the restaurant, leave work and just go back home, cry in your car, etc). From the start, we practice simple behavioral tools you can use right then to stop that spiral. This could also sometimes take the form of “as needed” medications, for when you’re trying to get to sleep that same night, or having a panic attack, for examples.

Medium-term (days to weeks): Some physical health interventions, for example if we find you have a treatable medical condition like thyroid problems, or PMS that responds to birth control. Some medications also work on this timeframe, as do circadian rhythm-based techniques I use (eg bright light therapy, dark therapy). The therapy side involves making sense of what’s happening in everyday life, that can involve reading, homework, and/or worksheets if you are interested. We also can do various exposure therapies for some fears or trauma. We practice skills in emotional regulation, communication, and other functions.

Long-term (month to multiple months): Some of the most effective medications available take 4-6 weeks or longer to see the full benefit. This is because they induce parts of your brain to form new connections, and that process takes time. [5] This can be especially frustrating if you do encounter side effects immediately and you’re waiting for the payoff. However it’s the most effective for numerous conditions including anxiety, PTSD, OCD, and depression. On the therapy side, the long-term intervention is a “psychodynamic” approach, whereby we gradually gain helpful insights from patterns in your past, and patterns in our interactions during therapy. These are intended to provide a more durable understanding than the coping skills we learned at first.