Wait, an antidepressant could help with weight loss?

Wait, an antidepressant could help with weight loss?

You may wonder why an antidepressant is being prescribed for weight loss. Read on to learn why bupropion is an all-around team player for weight care.

Morgan Pavon, MS, RD, LD
December 29, 2022
5 min read
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Yes, it’s true. An FDA-approved medication for depression is now being used to treat obesity. We’re talking about bupropion. It might sound weird, but there’s good science behind it. Here’s the deal:

How bupropion works—and may help with weight care

An imbalance of certain chemicals in the brain called neurotransmitters—specifically dopamine and norepinephrine—can to lead to depression. Bupropion, also known by the brand name Wellbutrin, works by increasing levels of these chemicals and improving symptoms of depression.    

Researchers aren’t exactly sure how bupropion works for weight loss. But it’s known to increase activity in certain pathways of the brain that may increase levels of dopamine and lead to decreased appetite, reduced food cravings, and an increase in the number of calories you burn. Doctors can prescribe this medication off-label to expand their patients’ weight care options.  

Bupropion, like many weight loss medications, is intended for patients with a BMI of 30 or higher or a BMI of 27 or greater with at least one weight-related health condition such as high blood pressure or type 2 diabetes. They are also meant for those who have tried behavioral interventions—diet, exercise—and couldn’t achieve or maintain results. 

Is bupropion really effective?

Very. After researchers noticed that people prescribed bupropion for depression also tended to lose weight, it sparked an interest in exploring its use in obesity medicine. One study published in the journal Obesity looked at the effect of bupropion on weight by prescribing 300 mg to one group of participants, 400 mg of bupropion to another, and a placebo (dummy pill) to a third group. Each group received counseling on lifestyle weight care interventions. At the end of 24 weeks, those prescribed 400 mg of bupropion lost an average of 10% of their initial body weight, compared to 7% in the group prescribed 300 mg, and 5% in the placebo group. Both groups given bupropion also maintained their weight loss at the 48-week mark.

According to another study of obese adults with mild-to-moderate depression in the same journal, some depressive symptoms appeared to be related to weight alone. Participants prescribed bupropion dropped significantly more pounds than those given a placebo (an average of around 5% versus 2% of body weight). But while both groups reported decreased depressive symptoms, greater improvements were seen when total body weight loss was 5% or more. So while medication is a valuable tool in treating depression, it also appears that weight loss on its own may help as well.

Why is bupropion often prescribed in combo with other medications?

Some things are better together. And substantial evidence supports that for weight loss and maintenance, bupropion (also used for tobacco cessation) may be even more effective when paired with other drugs. These other drugs are naltrexone—a medication approved for the treatment of opioid and alcohol use disorder—and zonisamide—a drug approved for the treatment of seizures. You may notice improvements in other conditions when prescribed the combos. 

Bupropion + zonisamide

Together, these medications target all three major neurotransmitters that regulate appetite: Bupropion works on norepinephrine and dopamine, while zonisamide acts on serotonin and dopamine. 

Why not use one or the other? The two medications result in more weight loss, perhaps due to their ability to target more areas of the brain. In fact,  in a phase 2B clinical trial, those prescribed Empatic360 (a combination of bupropion and zonisamide) lost, on average, nearly 8% of their body weight after 24 weeks, compared to 2% in those prescribed bupropion alone and 5% for those given only zonisamide. 

The possible side effects of bupropion

Many people don’t experience any side effects when taking bupropion. However, as with any medication, there is a possibility. Common side effects include nausea, vomiting, dizziness, headache, dry mouth, difficulty sleeping, and constipation—although they usually resolve in a week or two. 

When exploring your medication options with your provider, it’s essential to be honest about your personal and family health history to reduce your risk of side effects. Certain prescription drugs may be more or less appropriate, depending on your history. 

Bottom line

Bupropion, a powerhouse medication for the treatment of depression, may reduce appetite and cravings—leading to more effective weight loss and maintenance.


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Published date:
December 29, 2022
Ready to lose weight and live your healthiest life?
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Meet the author
Morgan Pavon, MS, RD, LD
Health writer
Morgan Pavon is a licensed and registered dietitian.

Sources

  • Stahl, S. M., Pradko, J. F., Haight, B. R., Modell, J. G., Rockett, C. B., & Learned-Coughlin, S. (2004). A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor. The Primary Care Companion to the Journal of Clinical Psychiatry, 06(04), 159–166. https://doi.org/10.4088/pcc.v06n0403
  • Anderson, J. W., Greenway, F. L., Fujioka, K., Gadde, K. M., McKenney, J., & O’Neil, P. M. (2002). Bupropion SR Enhances Weight Loss: A 48-Week Double-Blind, Placebo- Controlled Trial. Obesity Research, 10(7), 633–641. https://doi.org/10.1038/oby.2002.86
  • Wadden, T. A., Foreyt, J. P., Foster, G. D., Hill, J. O., Klein, S., O’Neil, P. M., Perri, M. G., Pi-Sunyer, F. X., Rock, C. L., Erickson, J. S., Maier, H. N., Kim, D. D., & Dunayevich, E. (2011). Weight Loss With Naltrexone SR/Bupropion SR Combination Therapy as an Adjunct to Behavior Modification: The COR-BMOD Trial. Obesity, 19(1), 110–120. https://doi.org/10.1038/oby.2010.147
  • Buoli, M., Grassi, S., Ciappolino, V., Serati, M., & Altamura, A. C. (2017). The Use of Zonisamide for the Treatment of Psychiatric Disorders: A Systematic Review. Clinical Neuropharmacology, 40(2), 85–92. https://doi.org/10.1097/wnf.0000000000000208
  • Haymarket Media. (2009, September 30). Phase 2b study of Empatic for weight loss. MPR. https://www.empr.com/home/news/drugs-in-the-pipeline/phase-2b-study-of-empatic-for-weight-loss/
  • Cenk Tek, C. (2016). Naltrexone HCI/bupropion HCI for chronic weight management in obese adults: patient selection and perspectives. Patient Preference and Adherence, 751. https://doi.org/10.2147/ppa.s84778
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