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Question. I have been taking 30 mg of Paxil daily for nearly two years. I have gained about 15 pounds that I can’t drop even though I’ve increased my activity level and decreased my food intake. All the literature mentions weight loss but nothing is said about weight gain. A friend taking Paxil also experienced weight gain, as have my husband and three friends who are on Prozac. How can a person avoid weight gain while using antidepressants, especially when the medication is designed to increase the appetite?

Answer. I appreciate your frustration – weight gain on antidepressants is a very common complaint, particularly with the “old” tricyclics. It is far less common with the agents known as SSRIs, which includes Paxil, Prozac, Zoloft, and Luvox. Antidepressants are not really designed to increase your appetite; some patients with depression actually gain weight as a result of their illness, and antidepressants often help them lose the weight. It would be more accurate to say that antidepressants are prescribed to treat depression, which – once alleviated – tends to normalize weight, up or down.

SSRIs are believed to decrease carbohydrate craving, thereby (for many patients) decreasing weight. Before assuming that you are gaining weight because of the Paxil, it would be important to consider other possibilities. A sluggish thyroid gland can account for weight gain, and it might be wise to have your TSH checked – this is a sensitive measure of low thyroid function. Although you may have increased your activity level and decreased your food intake, it isn’t necessarily clear that you have decreased your total caloric intake – it would take a nutritionist to determine that, and I would recommend you see one.

Cutting out specific kinds of foods and drinks – such as sugary and fatty ones – may be more important than just decreasing food intake. In theory, if you do nothing else but increase your walking by 15 minutes each day, you should be able to drop a few pounds over the next few months – so it would be wise to look at your exercise routine with your family doctor and see if it is safe to increase it.

Finally – though I am not recommending this – you could discuss a change in medication with your doctor, if this weight gain really disturbs you. Bupropion [Wellbutrin] or venlafaxine [Effexor]] could be good alternatives, and one of the other SSRIs (such as Prozac) would not necessarily have the same effect on your weight as Paxil. Sometimes dosage reduction (e.g., Paxil 20 mg/day) with addition of an adjunctive antidepressant (such as bupropion) can help shed a few pounds, but not always. I’d start with the nutritionist and the exercise evaluation – and good luck!