What Can Be Done For Prozac Weight Gain?

QUESTION:

Dr. Heller:

Hello, I'm a 38-year-old woman who has been on 20mg of Prozac for about 4 years now for treatment with my Raynaud's disease.  While it helps my condition enormously, I am about 25lbs overweight now, which is very frustrating.

My rheumatologist agreed that this is a common side-effect of SSRI's; however, he didn't advise taking me off the Prozac.

Any advice?  Would Wellbutrin be for me?

ANSWER:

First of all there are many other possibilities for the weight gain, as weight gain is an extremely rare side effect from Prozac.  The most common other reasons would be a thyroid disorder (primary or non-primary hypothyroidism), side effects from other medications, reduced exercise, polycystic ovary disease, or some additional collagen vascular disorder.

The patients I've seen gain weight on Prozac all had the GAD also.  The cognitive GAD is a genetic condition where the person constantly worries.  It appears to be an overactive serotonin 1A receptor, which will be increased by Prozac and other SSRI's.  If a person eats when anxious, this can cause weight gain.  If both the GAD and borderline disorder are present, the increased anxiety can trigger dysphoria (anxiety, rage, depression and despair) - which is often self-medicated with food.

If a lack of zest for life is present, or an inability to achieve orgasms is a problem, then Wellbutrin could be of great help.