Mirtazapine, an atypical antidepressant marketed under the brand names Remeron and Remeron SolTab, is a common medication prescribed to treat clinical depression, anxiety, and other mental health conditions. While Mirtazapine can be effective in managing symptoms of depression, some individuals experience significant food cravings and subsequent weight gain while taking it. Dealing with these uncontrollable cravings for high-carbohydrate, high-sugar, and highly processed foods can be extremely challenging, leading to distress from the resulting weight gain and its impact on overall health. This article explores the relationship between Mirtazapine and weight gain, providing insights into the underlying mechanisms and offering practical strategies for managing food cravings and maintaining a healthy weight while on this medication.
How Mirtazapine Causes Weight Gain
A study published in the peer-reviewed BMJ (British Medical Journal) found that people on antidepressants were over 20% more likely to gain weight, with those on Mirtazapine experiencing higher weight gain. The exact reasons for this weight gain are still unknown, but several theories exist.
Appetite Stimulation
One prominent theory is that Mirtazapine stimulates appetite, leading individuals to eat more food and consequently gain weight. People on Mirtazapine may find it difficult to fight hunger cravings and may tend to eat more carbohydrates and sugary foods. Mirtazapine is sometimes used off-label as an appetite stimulant.
Impact on Body Mass
Research suggests that Mirtazapine increases fat storage across the body by altering levels of leptin, a hormone that suppresses appetite. Lower leptin levels due to Mirtazapine may lead to increased fat mass.
Hormonal Imbalance
Mirtazapine may lead to a hormonal imbalance. Many individuals report experiencing cravings for foods rich in sugar, refined carbohydrates, and highly processed ingredients. This may be due to an imbalance of neurotransmitters and glucose levels that lead to cravings.
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Regardless of the underlying cause, the weight gain associated with Mirtazapine can be frustrating and demotivating. It may even lead some people to question whether the drug is worth it, even if it effectively manages their depression symptoms. However, there are strategies to handle these food cravings and mitigate weight gain.
Tips to Manage Mirtazapine Food Cravings
Suzanna Thoe, RD, a Registered Dietitian, offers several evidence-based strategies to manage food cravings while on antidepressants like Mirtazapine.
1. Choose Nutrient-Rich Foods
Foods rich in fiber can help you feel full longer and reduce the likelihood of cravings. This includes whole grains, whole fruits and vegetables, and lean proteins. Sugars and starchy foods break down easily in your body and elevate your blood sugar levels. This leads to an insulin spike (insulin clears the sugar out of your bloodstream), which can lead to low blood sugar. To compensate for this low blood sugar, your brain may crave sugary foods and refined carbs for an energy boost. Unfortunately, this vicious cycle and extremes of blood sugar levels can lead to insulin resistance, which can also lead to weight gain. Whole grains and whole vegetables take longer to digest due to the fiber and nutrients in them, which allows a steady trickle of glucose in the bloodstream. Eat your proteins together with nutrient-rich carbohydrates for optimal nutrition.
2. Eat at Regular Intervals
Whether you are hungry or not, try to eat at regular intervals. If not, the resulting low blood sugar levels may increase your urge to eat high-sugar and high-carb foods. Balancing your blood sugar levels has been proven to help you feel more energetic and reduce cravings. Eating carbohydrates like whole grains and vegetables can help you maintain steady blood glucose levels throughout the day. Try and keep nutritious but easy-to-grab snacks on hand. This can include whole fruit, nuts, boiled eggs, hummus and cucumber slices, and peanut butter with apple slices.
3. Drink More Water
You may crave sugar-rich drinks or sodas, but try and drink water at regular intervals during the day. Sometimes, thirst can be mistaken for hunger and can lead to the urge to eat foods low in nutritional value. If you would like an alternative to water, you could try herbal teas, green tea, or decaf teas. Adequate water intake can aid in weight loss as well as help you maintain a healthy weight. Adequate hydration improves appetite control and reduces unnecessary snacking.
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4. Engage in Physical Activity
Research shows that exercise like running or strength training can help delay hunger. More importantly, while exercise does not help you lose weight, it brings loads of health benefits and can serve as a distraction from cravings. A regular exercise routine can help to support a healthy weight, reduce weight gain, and improve mental health. You could try joining a group class or walking with friends or co-workers to help distract you from your food cravings, even temporarily.
5. Consult a Licensed Registered Dietitian
Remember, everyone's experience with antidepressants is unique. Your body may respond differently to antidepressants compared to another person. Weight gain is an incredibly complex process and not a simple calories-in, calories-out concept as the common myth tells us. Also, fighting cravings involves balancing various chemical, hormonal, and nutritional factors. Apart from these issues, dealing with changes in weight can be difficult if you have a history of disordered eating or issues with gut health. Be kind to yourself; it is extremely challenging to deal with depression as well as the side effects of your medication. Consider getting support right from the start. At Fay, Registered Dietitians will first understand your unique challenges and create a personalized nutrition plan, just for you. What's more, your Registered Dietitian can offer guidance as you adjust to your new medication and help you get the right nutrition you need. Fay can help you find a Registered Dietitian near you, covered by your insurance. Working with a Registered Dietitian (RD) can allow you to develop the skills you need to manage both your mental and physical health during this time. RDs are nutrition professionals who can guide you and support you in improving your diet and lifestyle in a variety of ways. RDs can teach you to manage both the short and long-term effects of antidepressant medications such as Mirtazapine, guide you to overcome barriers, and provide individualized recommendations to steer you toward success. If you’ve never worked with an RD before, now is a good time to consider getting additional support. It may seem easy on the outside, but once you start feeling the effects of this medication, it can be frustrating to manage on your own. Don’t wait until it’s too late.
Additional Tips for Managing Weight on Mirtazapine
- Choose a Higher Protein Diet: Protein is one of the most satiating nutrients. Consuming a high-protein diet can aid in meal satisfaction and increase fullness, leading to less snacking and smaller portions.
- Incorporate Satiating Foods: Aside from protein, consuming more foods that contain fiber or healthy fats such as fruits, vegetables, nuts, olive oil, and avocados can slow down gastric emptying, keeping you feeling full for longer, and aid in appetite regulation.
- Avoid or Limit Highly Processed and Sugary Foods: Mirtazapine can increase cravings for high-carb, processed food items which are known to cause weight gain.
- Track Your Food and Liquid Intake: Keep track of how much you are consuming by using an app or paper log to note your intake of both foods and liquids. This can keep you accountable and make you aware of any changes that occur in your diet.
- Consider Meal Prepping: Meal prepping with a focus on weight loss can help you stay on top of your diet when it comes to both the quantity and quality of foods you are choosing. Meal prepping also encourages consuming home-cooked meals versus processed foods or foods out.
- Keep Healthy Snacks on Hand: Because your appetite will be increased on Mirtazapine, keeping healthy snacks that contain protein, fat, and/or fiber can be beneficial to avoid over-eating processed snacks. Try snacks like nuts that can help with weight loss.
- Get Plenty of Sleep: Chronic sleep deprivation can increase snacking behaviors and rev up appetite. This combined with the effects of Mirtazapine can worsen weight gain. Aim for seven to nine hours of high-quality sleep every night as possible.
Mirtazapine and Functional Dyspepsia (FD) Patients with Weight Loss
Functional dyspepsia (FD) is a common clinical syndrome characterized by chronic and recurrent symptoms in the gastroduodenal region in the absence of any organic or metabolic disease that explains the symptoms. Weight loss is a common symptom of digestive diseases, and may indicate an organic disease. A study investigated the effects of mirtazapine on depressive FD patients with weight loss. Mirtazapine showed higher efficacy in relieving dyspeptic symptoms and lowering NDSI scores when compared to paroxetine and conventional treatment, and was equal to paroxetine in mitigating depressive symptoms. The study showed that mirtazapine treatment of depressive FD patients with weight loss not only effectively treated symptoms of dyspepsia and depression, but also induced significant weight gain, an effect not observed with either paroxetine or conventional treatment. Specifically, 80% of the patients experienced weight gain after 4 wk of treatment with mirtazapine; furthermore, 95% of these patients continued to gain weight until the end of the treatment. The average weight gain was 3.58 ± 1.57 kg, resulting in significantly higher weight than the baseline weight recorded before treatment. In humans, weight is mainly composed of muscle volume, body fat, and inorganic salts, and muscle volume and body fat are the most affected. Through dynamic observation of the weight distribution of the various body components, it was found that muscle volume stayed relatively constant throughout treatment, whereas body fat significantly changed. Body fat, which includes subcutaneous fat, visceral fat, muscle clearance fat, proved to be the main contributor to body weight gain. In conclusion, antidepressant mirtazapine not only improved patients’ conditions concerning indigestive and depressive symptoms, but also increased appetite and body weight (mainly the visceral fat in body fat), much more effectively than either paroxetine or conventional therapy.
Important Safety Information
It is very important that your doctor check your progress at regular visits, to allow changes in your dose and help reduce any side effects. Blood tests may be needed to check for unwanted effects. Do not take mirtazapine with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], linezolid [Zyvox®], methylene blue injection, phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start taking mirtazapine during the 2 weeks after you stop a MAO inhibitor and wait 2 weeks after stopping mirtazapine before you start taking a MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe seizures. Mirtazapine may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use mirtazapine with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John's wort, or some pain or migraine medicines (eg, rizatriptan, sumatriptan, tramadol, Frova®, Imitrex®, Maxalt®, Relpax®, Ultram®, Zomig®). Check with your doctor first before taking any other medicines with mirtazapine. Check with your doctor right away if you are having agitation, difficulty in breathing, a fast heartbeat, hallucinations, a high fever, high or low blood pressure, increased sweating, loss of bladder control, seizures, severe muscle stiffness, unusually pale skin, or tiredness while you are taking this medicine. Mirtazapine may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide. This medicine may add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are taking this medicine. This medicine can temporarily lower the number of white blood cells in your blood, increasing your chance of getting an infection. If you can, avoid people with infections. Check with your doctor right away if you think you are getting an infection or if you have a fever or chills, sore throat, sores in the mouth, lower back or side pain, or painful or difficult urination. Do not suddenly stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping completely. This may help prevent a possible worsening of your condition and reduce the possibility of withdrawal symptoms such as headache, nausea, or a general feeling of discomfort or illness. This medicine may increase your weight. Your doctor may need to check your weight on a regular basis while you are using this medicine. Mirtazapine may cause drowsiness, trouble with thinking, or trouble with controlling body movements. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that requires you to be alert, well-coordinated, and able to think well. This medicine may cause serious skin reaction, including drug reaction with eosinophilia and systemic symptoms (DRESS). Check with your doctor right away if you have black, tarry stools, chest pain, chills, cough, fever, painful or difficult urination, sore throat, sores, ulcers, or white spots on the lips or in the mouth. swollen glands, unusual bleeding or bruising, or unusual tiredness or weakness. Hyponatremia (low sodium in the blood) may occur with this medicine. This is more common in elderly patients, those who are taking diuretic medicines for high blood pressure, or those who have decreased amounts of fluid in the body due to severe diarrhea or vomiting. Check with your doctor right away if you have confusion, difficulty concentrating, headaches, memory problems, weakness, and unsteadiness. Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help. If this problem continues or gets worse, check with your doctor. Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
FAQs about Weight Gain & Mirtazapine
- Does 7.5mg of Mirtazapine cause weight gain? Even low doses of Mirtazapine, such as 7.5mg, are associated with weight gain. However, higher doses are associated with higher rates of weight gain.
- Does 15mg of Mirtazapine cause weight gain? As mentioned above, higher doses of Mirtazapine are more likely to result in higher rates of weight gain. Both 7.5mg and 15mg will likely cause weight gain as a common side effect however, those taking 15mg may notice more significant weight gain depending on how long you take the medication.
- How long does it take for Mirtazapine to increase appetite? An increase in appetite while taking Mirtazapine can be expected within the first few doses. One study found that most experienced appetite stimulation within the first four days of taking Mirtazapine with the most significant change noted after the first two days of use.
- How long does it take to gain weight on Mirtazapine? Most studies conducted on weight gain while taking Mirtazapine suggest that the majority of weight gain occurs within the first couple of months of taking it.
- What is the average weight gain on Mirtazapine? According to the Journal of Clinical Psychiatry, an average weight gain of 4.4 lbs after six weeks of treatment has been reported with Mirtazapine.One study conducted on 362 patients taking antidepressant drugs, including Mirtazapine, for 6 to 36 months found that 55% experienced weight gain with over 40% of patients having weight gain of 7% or more of their body weight.
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