Depression Symptoms Treatment

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Question.  My wife was diagnosed with depression and has tried various drug regimens. After trying many other meds, she recently began taking Remeron. Her depression has improved greatly, but I am afraid it may not last because she has gained 15 to 20 pounds while on Remeron. Since her physical appearance means a lot to her, I can see the negative effect it is having. Is this a possible side effect? What else can we expect?

Answer. Unfortunately, the scenario you describe is not uncommon with Remeron. Significant weight gain occurs in at least 10% of patients and probably more. Other side effects with Remeron include increased appetite (15% of patients), drowsiness (36%), dry mouth (10%) and constipation (6%). There is also a rare blood disorder that can occur in about 1 in 1000 patients (agranulocytosis), though that figure may be an overestimate. It is always difficult to advise a patient who is otherwise feeling good on a medication, but is gaining a great deal of weight. There is no easy solution to this. It is important both to reduce dietary fats/sugars and to increase one’s daily exercise. It’s also important to make sure that the patient’s thyroid is not underactive. But even after doing these things, many patients do not lose the weight they have put on. Unless your wife’s weight gain puts her into the obese range, I would not advocate use of the new weight loss medications such as fenfluramine and phentermine; I think these can have their own risks when used long term.

It might be possible to reduce the dose of Remeron slightly and to try augmenting it with another antidepressant that does not promote weight, such as Wellbutrin or Ritalin. However, these combinations have not been studied systematically. I do recommend getting some dietary counseling from a registered dietitian. You would be surprised how many high-fat foods people eat without being aware of it. And anything your wife can do to increase her exercise, even adding 15 minutes of walking each day, will help keep off the pounds.