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Amitriptyline & Weight Gain: The Reason 50% Discontinue Treatment

Amitriptyline (Elavil) is the most popular TCA (tricyclic antidepressant) medication on the market. It is primarily utilized for the treatment of depression, and in other cases, migraine headaches and anxiety disorders. The drug functions primarily by inhibiting the reuptake of the serotonin transporter, which increases extracellular levels of the neurotransmitter serotonin. Although serotonin is primarily responsible for producing its antidepressant effect, the drug also affects other neurotransmitters like norepinephrine to a minor extent.

Although TCAs are seldom prescribed as a first-line treatment for depression, some individuals actually find that they work better than SSRIs and other new antidepressants. If a person fails to respond to several newer drugs, a psychiatrist will likely prescribe a TCA – and due to the fact that Amitriptyline is the most popular, it’s what most people end up taking. Like all antidepressants, this drug tends to yield side effects, one of which may be unwanted weight gain.

Amitriptyline and Weight Gain

Some studies have estimated that 50% of all patients who discontinue treatment with a tricyclic antidepressant (TCA), do so because they’ve experienced excessive weight gain. For this reason, some people may find that Amitriptyline works extremely well for their depression and balancing their mood, but they may not be able to put up with the increase in weight. Let’s face it, gaining weight can (in some cases) override the antidepressant effects of the drug and actually contribute to depression as a result of poor body image.

How Amitriptyline Causes Weight Gain

There is an array of research that has been conducted with Amitriptyline to investigate how the drug may cause weight gain. Researchers have long claimed that this medication can alter your hormone levels, cause you to crave sweets/carbohydrates, and increase your appetite. If you gain weight while taking this particular medication, below are some reasons that may help you understand why.

  • Appetite increase: Some studies have determined that Amitriptyline can be administered to individuals suffering from eating disorders like anorexia and effectively boost their appetite. If you have been taking the drug and notice that you’re a lot hungrier than usual, it could be that the drug is making you feel hungrier than normal (for a variety of reasons).
  • Craving carbohydrates: There are multiple studies that have found that those who take Amitriptyline tend to experience an increase in cravings for “sweets” and carbohydrates. It is known that carbohydrates will cause weight gain if they are not properly used and/or eaten in excess. The cravings may stem indirectly from this drug’s effect of raising serotonin levels – a neurotransmitter directly tied to carbohydrates.
  • Depression reduction: Some people who are depressed tend to under-eat, leading to a weight loss. Assuming this drug is working to effectively treat the depression, the person may realize that they should resume normal eating habits. This may lead the person to re-gain the weight that was lost during a depressive episode.
  • Fat storage: The body tends to store fat differently when we are taking certain antidepressant medications compared to during homeostatic functioning. This is due to the fact that medications tend to alter metabolic functions as well as various hormones. When hormone levels are altered, some people have a tendency to pack on extra fat with relative ease.
  • Hormone levels: Perhaps another important clue to weight gain that people experience on Amitriptyline is the change in the level of various hormones, particularly that of “leptin.” This hormone is involved in appetite regulation and hunger. When levels of leptin increase (as caused by the drug), we feel hungrier more often, and are more likely to eat.
  • Motivation reduction: The fact that this medication is known to decrease energy levels in those that take it, this often leads to reduced motivation. When your motivation plummets, you are going to have a much tougher time getting your butt up to exercise as well as plan healthy meals; this leads to weight gain.
  • Sedation: A very common side effect that people experience from Amitriptyline is that of sedation. This is considered one of the most sedating TCA medications, leading people to feel fatigued, sleepy, and tired while taking it. If you feel more tired than usual, you may end up exercising less and sleep more – leading to less calories burned and a slower metabolism.
  • Slow metabolism: It is thought that you may experience a slowed metabolism as a result of many of the other factors on this list. Assuming the drug alters your hormones and makes you feel sedated, those to effects alone may contribute to a slow metabolism. Others speculate that the drug-induced physiological changes result in a slowing of the metabolism – leading to weight gain. If you have maintained the same diet and exercise habits throughout your treatment as you did pre-drug, and gain weight, it could be due to metabolic slowing.
  • Social eating: If the drug is working well to treat your depression and/or anxiety, there’s a chance that you may start to socialize more frequently. Frequent socialization often leads to social eating, or eating out with friends. If you end up eating out more than usual, you’re probably going to end up gaining weight.
  • Taste perception: When depressed, some people claim to have a blunted perception of taste or that food just doesn’t seem to have the same pizzazz. If this medication works well to improve your mood, you may find that your taste also improves, leading you to eat more often (and possibly larger portions), both of which can lead to weight gain.

Note: It is important to understand that although many of the factors listed above can cause weight gain, they degree to which they affect you is highly individualized. One person may start eating out with friends more often on the drug, while another may simply become tired, lethargic, and unmotivated. Keep in mind that the path to gaining weight on any medication is often subject to individual variation.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/6754192
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/16232156
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/4588039

Factors that influence weight gain on Amitriptyline

There are other influential factors that can determine how much weight gain you experience on Amitriptyline. These include things like: the dosage you take, how long you’ve been medicated, your lifestyle, whether you take other drugs, as well as your genetics.

1. Dosage

Studies have shown that even if you are taking low-moderate doses of Amitriptyline, you may still gain weight. That said, if you are concerned about weight, it is always recommended to take the minimal effective dose to treat your depression. The higher the dose you take, the more likely you are to gain weight as well as amplify any existing weight gain you’ve experienced.

When taking high doses, the drug tends to have more influence over your physiological functioning. With increased influence, its effects on neurotransmitters like serotonin become amplified, but so do its unwanted side effects like weight gain. Some people claim that there is a direct dose-weight relationship associated with Amitriptyline.

2. Time Span

How long have you been taking this medication? Those that have been on it for years already have likely adapted to its effects and have (in all likelihood) maxed out their potential weight gain. Those that have been on the drug for a long-term likely have experienced some change in weight as well as BMI throughout their treatment.

It should also be mentioned that the longer you are on this drug, the more likely you are to have become tolerant, and thus need to increase your dosage (which we know can lead to weight gain). Those that use the drug over a very short-term may not notice as much weight gain simply because the body may not have fully adapted to the drug. Unfortunately many people end up having to discontinue after just a moderate term (6 months to 1 year) because their weight has ballooned.

3. Lifestyle

While it may be easy to place complete blame on the Amitriptyline for the weight that you’ve gained, it is also important to evaluate your lifestyle. Take the time to consider whether you practice healthy eating, get enough sleep, minimize your stress, and make exercise a priority. If you aren’t getting any exercise, are highly stressed, and are eating garbage foods – your lifestyle may be more of a contributor to your weight gain than the drug you’re taking. Practice healthy habits so that you know whether it is really the drug causing you to gain weight.

4. Other drugs

Also think about whether you are taking any other medications. If you are taking an antipsychotic drug, those are associated with more significant weight gain than Amitriptyline. If you are on an array of different medications, it may be helpful to have a discussion with your doctor about which drugs are most likely causing your weight gain. Also keep in mind that those who don’t gain weight on this drug may be unknowingly offsetting the weight gain if they simultaneously take a stimulant medication and/or drug associated with weight loss.

5. Genetics

Another explanation for why you gain weight on this drug and another person doesn’t could be due to genetics. Each person has a unique genetic code and genetic variants that respond to this medication. If your genetics aren’t a good fit for the drug or make you more susceptible to weight gain based on this drug’s mechanism of action, you’re going to have a more difficult time staying slim. Fortunately there are new technologies in the works like GeneSight that analyze your genetic code to predict how you’ll respond to various antidepressants.

How much weight will you gain on Amitriptyline?

Unfortunately there is minimal research documenting exactly how much weight people gain while taking Amitriptyline. Some studies that analyze tricyclic antidepressants (including Amitriptyline) have reported that people tend to gain between 1 lbs. and 3 lbs. per month while taking the medication for 6 months. Among those taking TCAs, people tend to gain anywhere from 3 lbs. to 16 lbs. after being medicated for 6 months. Since Amitriptyline is one of the more sedating TCAs on the market, some speculate that more weight gain is common.

Does Amitriptyline cause everyone to gain weight?

Not everyone gains weight on Amitriptyline. As was already mentioned, weight gain is highly based upon individual factors such as genetics, lifestyle, and whether you’re taking other medications. That said, most people who are only taking Amitriptyline are likely to experience some weight gain. While it may be discouraging to gain some weight, with adequate exercise and healthy dietary intake, it can be minimized.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/6238068

Should you discontinue treatment if you gain weight?

Up to 50% of all people who discontinue this drug do so because of weight gain. If you are planning on quitting this particular drug, you may want to talk to your doctor about other options. It is important to always weigh the therapeutic benefit you are getting with the unwanted side effects such as weight gain. If the weight you’ve gained has become problematic and impairs your functioning, you may want to consider Amitriptyline withdrawal.

However, if the drug is working well to keep your major depression under control, you may be able to justify some weight gain. Never be too quick to discontinue a drug just because you’ve packed on a few pounds. Proper interventions such as daily exercise, changing your diet, and possibly other medications may be able to help offset the weight gain; talk to your doctor about what can be done.

Did you gain weight while taking Amitriptyline?

If you’ve taken this drug (or are currently taking it) and have experienced weight gain, be sure to talk about it in the comments section below. It may be helpful if you include some specific information such as how long you’ve been taking the drug, when you first noticed the weight gain, your dosage, and other medications. Also mention why you believe the drug caused you to gain weight. Even if you didn’t gain any weight (or are a rare person who lost weight) on this drug, you are welcome to join the discussion.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/2975806
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/872612

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{ 123 comments… add one }
  • Susan May 23, 2018, 1:00 am

    On 25mg a night for vulvodynia. No one else commented with this condition. Have gained 10 to 15 lbs. Have been in it for at least 3 years.
    The condition is not only painful but something no one wants to talk about. Anyway it has helped wonderfully.

    It does make me drowsy and listless sometimes but being mostly pain free is worth it. I do consciously pay attention to what I eat but the cravings do get the best of me.

    I guess you have to weigh the benefits to the side effects and decide if you’d rather be sooo uncomfortable that you can’t even sit in the car – or get some relief from this drug.

  • Teepots May 19, 2018, 12:59 pm

    I had horrendous insomnia for nearly 15 years, before taking Endep, and now I no longer have the problem I have felt so much better. I take 50mg and have done so for 3 years now, I have tried taking less but this is the dose I need to sleep.

    I have put on about 4.5kgs (female), and have a bloated stomach. I have noticed a few things about the weight gain that I hope may help readers:

    1) This drug makes you constipated and slows your digestion, for me I am sure this has led to my weight gain, about six months ago found a herbal tonic for constipation that seems to speed my whole system up again.

    2) Anything else that gets your digestive system going will help, such as yoga twists, or very vigorous sweaty exercise, gentle exercise doesn’t work as well.

    3) After consulting many specialists I also employ another technique which does help my insomnia. I go to bed quite late and I get up early, I limit the time I try to sleep to about 6 hours overall, and this helps and some days I can reduce the medication a little. Best of luck everyone!

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