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  • Q&A with Australian Health Practitioners

    How can I control my appetite while on antidepressants?

    I’m currently trying to lose weight but since starting an antidepressant my appetite has increased significantly. I started Avanza (mirtazapine) on 15 mg for three weeks before switching to the higher dosage of 30mg one week ago. Increased appetite is a common side effect but I’m struggling not to overeat and eat all the wrong things. I eat 3 meals, and 3 snacks including food high in fibre and protein. I also drink 2L of water a day but my cravings are still uncontrollable. How can I control my appetite without changing my medication?
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    Arlene is a registered practising dietitian, with a private practice in the Eastern Suburbs of Sydney, and has built a strong business over the last … View Profile

    Helping people successfully lose weight while on antidepressants (and preventing it in the first place) is often what I do in my practice. It's such a common problem and I think everyone on antidepressants should know that it is possible to benefit from the medications AND maintain a healthy weight.

    Antidepressants have wonderfully positive benefits not only in treating depression but increasingly are used also for a number of other conditions such as chronic pain like fibromyalgia, migraines, PMS, and even some urinary symptoms. The down side is that weight gain is an unwanted side effect associated with a majority of the antidepressants out there. And unfortunately, many people are completely unaware of potential weight gain when they start taking their medications - prescribing physicians seem to never mention it!

    And how many of you, when the weight has crept on, have asked your doctor what's going on and gotten no satisfying answers? Or wondered why all of a sudden you can't stop eating chips, bagels, or ice cream?

    Many antidepressants improve mood by making brain serotonin, a chemical that we all have in our brains, hang around longer between the nerve endings. Serotonin is a “feel good” natural chemical. It also is involved in controlling appetite. And for some reason that is not understood, antidepressants can make the appetite control effects of serotonin less effective. The result is that antidepressants can be associated with an out-of-control appetite and, eventually, weight gain.

    For people on antidepressants, common weight loss strategies like keeping a food journal, increasing exercise, or trying a low-carbohydrate/high protein diet are less effective than they are for people not on these medications. The reason is that these strategies do not address the fundamental problem: controlling appetite. The good news is that it is possible to naturally raise your brain serotonin by eating the right foods. And it's often music to peoples' ears that carbohydratess are the foods that allow your brain to make more serotonin which controls the appetite.

    Won't eating carbohydrates make me fat?  Not if you choose low-fat carbohydrates in the correct quantities. You have probably experienced the effects of “comfort foods” in making you feel good and satisfying your appetite - grilled chicken and steamed broccoli, while delicious and healthy, are not the foods you reach for when you get food cravings or feel stressed. No, mashed potatoes, a bowl of oatmeal with brown sugar, pizza, or brownies are more like it! The problem with cutting out carbohydrates is that your appetite can get out of control. The problem with eating the wrong carbohydrates, like those loaded with fat or refined sugar, is they can make you feel sluggish and add unwanted calories.

    Check with a dietitian first to guide your diet and monitor portions. But you can time your foods for maximum appetite-controlling effects. Levels of serotonin naturally decline by afternoon and evening So aim to eat carbohydrates like whole wheat pasta with vegetables for dinner and grab a raisin toast as a late afternoon snack, and stick to protein-packed breakfasts and lunches to keep you going during the day. Regular exercise is highly recommended.

    Bottom line: on antidepressants, you can control your appetite and lose weight.

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