Antidepressants are among the most frequently prescribed medications in the United States. Depression and weight changes, particularly weight gain, are common struggles for those with the condition. A 2015 study in the Journal of Clinical Medicine found that Wellbutrin, an antidepressant medication, helped curb depressive symptoms and weight gain. Given that people with hypothyroidism often experience both weight gain and symptoms of depressive disorder, it's essential to explore the potential interactions of medications like levothyroxine (Synthroid) and Wellbutrin (bupropion) and their effects on weight.
Understanding the Medications
Levothyroxine (Synthroid)
Synthroid is a brand-name oral tablet prescribed for hypothyroidism and, in certain situations, thyroid cancer. It contains the active ingredient levothyroxine and belongs to the thyroid hormone drug class. Synthroid is approved by the Food and Drug Administration (FDA) for use in adults and children to:
- Treat hypothyroidism
- Suppress (decrease) thyroid-stimulating hormones, which can help treat a certain type of thyroid cancer
The thyroid gland, located in your neck, produces hormones that regulate metabolism, digestion, heart function, muscle control, brain development, bone health, and even mood. Levothyroxine replaces what the body isn't getting when the thyroid gland doesn't produce enough hormone (hypothyroidism).
Wellbutrin (Bupropion)
Wellbutrin, known best by its brand name, is a medication used to treat depression. Also prescribed under the generic name bupropion, Wellbutrin is an atypical antidepressant, meaning it doesn't fall into a specific category like SSRIs or SNRIs. Wellbutrin works by altering neurohormones in the brain, specifically targeting norepinephrine and dopamine, making these hormones available in the brain for a longer time. Wellbutrin may improve:
- Focus and concentration
- Symptoms of ADHD
- Depressed mood
- Feeling worthless or hopeless
- Loss of interest and pleasure
- Low energy
- Agitation
- Slowed thoughts and movements
- Suicidal thoughts or actions
- Poor sleeping and eating habits
- Smoking addiction
One of the "off-label" uses of Wellbutrin is for weight loss. Because of how Wellbutrin affects dopamine and norepinephrine, many people see a change in their eating habits. In addition, some people find that this medication suppresses their appetite, making it easier for them to lose weight.
Read also: Does Levothyroxine Cause Weight Loss?
Potential Interactions Between Levothyroxine and Wellbutrin XL
According to available data, there are no known interactions between levothyroxine and Wellbutrin XL. However, this does not necessarily mean no interactions exist. It's crucial to consult with a healthcare professional for personalized advice.
Important Considerations
- Alcohol: Using bupropion with alcohol may increase the risk of uncommon side effects such as seizures, hallucinations, delusions, paranoia, mood and behavioral changes, depression, suicidal thoughts, anxiety, and panic attacks.
- Timing of Levothyroxine Dose: The timing of meals relative to your oral levothyroxine dose can affect the absorption of the medication. Therefore, levothyroxine should be taken on a consistent schedule with regard to time of day and relation to meals to avoid large fluctuations in blood levels, which may alter its effects.
- Food Interactions with Levothyroxine: Absorption of levothyroxine may be decreased and/or delayed by foods such as soybean flour, cottonseed meal, walnuts, dietary fiber, calcium, calcium-fortified juices, and grapefruit or grapefruit juice. These foods should be avoided within several hours of dosing if possible.
- Multivitamins: Using a multivitamin with minerals together with levothyroxine may decrease the effects of levothyroxine. You should separate the administration of levothyroxine and the multivitamin by at least 4 hours.
- Caffeine: Both bupropion and caffeine can increase blood pressure, and using them together may have additive effects.
- Nicotine: Using bupropion and nicotine together can cause an increase in blood pressure.
Weight Changes and Antidepressants
Body weight changes, particularly weight gain, have been associated with antidepressant use in multiple studies. The National Health and Nutrition Examination Surveys of 2005-2008 suggest that about 11% of Americans aged above 12 years old were on antidepressants. Antidepressants were the third largest prescription medication, majorly prescribed for depression, and their rate of use increased nearly 400% from 1988-1994 through 2005-2008.
Antidepressants and Weight Gain
Antidepressants such as tricyclics and monoamine oxidase inhibitors have been repeatedly associated with weight gain. The second generation of antidepressants, selective serotonin reuptake inhibitors (SSRIs), which were initially expected to have less effect on weight, later proved to have a close association with weight gain.
A study using the Allscripts data warehouse to identify patients on monotherapy of five selective serotonin reuptake inhibitor (SSRI) drugs (escitalopram, sertraline, citalopram, paroxetine, fluoxetine), one selective norepinephrine reuptake inhibitor (SNRI) duloxetine, and the aminoketone bupropion for at least 180 days. The study also identified patients on co-medication of SSRI/SNRI drugs with bupropion. Six ANCOVA models were built to compare the short-term effects on BMI among monotherapy and co-medication groups.
The study found:
Read also: The Wellbutrin weight loss timeline
- Monotherapy of all the SSRI/SNRI drugs showed significant weight increase, consistent with that of previous studies.
- The co-medication of bupropion and escitalopram showed a significantly higher increase in BMI than monotherapy (P = 0.0102).
This suggests an adverse weight gain on co-medication of escitalopram and bupropion, which warrants further validation studies.
Bupropion and Weight Loss
On the contrary, bupropion of the aminoketone class has been consistently associated with weight-neutral to modest weight loss effects. The unique clinical profile of bupropion leading to dual norepinephrine and dopamine reuptake inhibition, devoid of serotonergic effects, alleviates bupropion from the common side effects of older antidepressants, thereby accounting for the weight loss.
Factors Influencing Weight Changes
Several factors can influence weight changes during antidepressant therapy:
- Time and Dose: Time and dose-dependent weight gain on monotherapy of antidepressants have been broadly elaborated.
- Comedication Effects: The comedication effects of antidepressants as a result of augmentation strategy have not been widely addressed.
- Duration and Adherence to Therapy: Duration, adherence to therapy, and dosing of bupropion can impact the degree of weight loss.
- Lifestyle Factors: Other lifestyle factors such as diet and exercise can also impact the degree of weight loss.
Is Wellbutrin Safe for Thyroid Patients?
Depression and weight gain are both common symptoms in hypothyroidism (underactive thyroid) and Hashimoto's disease. For patients taking thyroid medication, there are usually no contraindications to using Wellbutrin with your thyroid medications-meaning, there should be no adverse effects to taking both drugs together. However, before using medication for weight loss, it is crucial to get to the root cause of your weight gain and first treat that appropriately.
Weight-Loss Strategies for Hypothyroidism
- Take your thyroid medication as prescribed: Low thyroid hormones may be causing some weight gain.
- Make thyroid-healthy changes to your diet: Remove any dietary triggers that may worsen inflammation from Hashimoto's and focus primarily on having plenty of veggies with a lean protein source.
- Check other hormone levels: Insulin and leptin resistance can show up in people with hypothyroidism and often make weight loss more challenging.
- Get regular exercise: Daily exercise, even in short bouts, is beneficial for your mental and physical health.
Side Effects of Synthroid
Synthroid can cause mild or serious side effects. It’s important to note that most of the side effects of Synthroid are caused by having high levels of thyroid hormones in your body. Even small changes in your Synthroid dose may cause large changes in your hormone levels, which could cause side effects. Be sure to talk with your doctor about any side effects you’re having with Synthroid. In some cases, your doctor may need to adjust your dosage of the drug.
Read also: Wellbutrin XL: Understanding Its Impact on Weight
Common Side Effects of Synthroid
Mild side effects of Synthroid can include:
- Shortness of breath
- Muscle spasms or weakness
- Hair loss
- Anxiety or irritability
- Trouble sleeping
- Increased appetite
- Diarrhea
- Rash
- Irregular periods in females
- Weight loss or weight gain
Serious Side Effects of Synthroid
Serious side effects from Synthroid aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Serious side effects and their symptoms can include:
- Heart problems, such as irregular heart rate or palpitations.
- Heart attack.
- Decreased bone mineral density, which can occur if you’re taking too much Synthroid.
- Allergic reaction
Side Effects in Children
Children taking Synthroid may have side effects that differ from those experienced by adults taking the drug. For example, some children taking Synthroid have had pseudotumor cerebri (increased pressure in the brain). In addition, some children taking Synthroid have had slipped capital femoral epiphysis. Also, certain bone growth problems may occur in infants and children who take too much Synthroid.
Contraindications for Bupropion
Bupropion is contraindicated in patients with:
- A seizure disorder
- Current/prior diagnosis of bulimia or anorexia nervosa
- Undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs
Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions.
Monitoring and Management
Patients of all ages treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of drug therapy, and at times of dose changes. Family members/caregivers should be advised to monitor for changes in behavior and to notify the health care provider.
Weight management in depression patients is a crucial aspect of a well-thought-out treatment plan. Apart from promoting adherence to the therapy, weight management can help in keeping other metabolic comorbidities at bay. A prudent antidepression regimen can benefit from a careful selection of antidepressants based on individual drugs and comedication risk profiles, also taking into account anthropometric measures and baseline metabolic assessment.
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