Do Long-Term Use of Lexapro and Prozac Cause Weight Gain?

I would like to ask the doctor if long-term use of Prozac and Wellbutrin can lead to weight gain?

Because the doctor diagnosed me with obsessive-compulsive disorder (OCD), I need to take these two medications.
However, I feel that taking fluoxetine causes me to retain water.
I have been on medication for OCD for seven to eight years.
There was a time in Taitung when I experienced similar obsessive thoughts but did not seek treatment.
I couldn't sleep and had thoughts like wanting to yawn but couldn't.
Eventually, I managed to improve by reading books on my own for a year or two, but I still experience some social anxiety.
For example, I feel anxious watching TV because I'm afraid of the people next to me.

There was also an incident when I went to a massage parlor.
The website required reservations, and a user online mentioned that the staff resembled a type I liked, so I decided to go.
However, that massage parlor turned out to be a front for illicit services.
Initially, the manager said they had legitimate services available, but when the new staff came in unexpectedly, she suddenly tried to engage in sexual acts with me.
I felt a bit angry at that moment but didn't dare to express my anger.
I mentioned that excessive masturbation could lead to erectile dysfunction.
After returning home, I couldn't stop thinking about these issues and had trouble sleeping.
Eventually, I consulted a psychiatrist who diagnosed me with obsessive thoughts.

I would like to ask if the experience at the massage parlor could have triggered a relapse of my OCD? Thank you, doctor.
Sometimes, when I go out and there are many people, my symptoms flare up, and I become fearful of harming others, leading me to overthink.

Ku Ku, 30~39 year old female. Ask Date: 2023/02/14

Dr. Wu Enliang reply Psychiatry

Generally, Wellbutrin (bupropion) tends to cause a decrease in appetite, leading to weight loss rather than weight gain.
On the other hand, Seroquel (quetiapine) may potentially lead to weight gain due to improved appetite.
However, there are many factors that can contribute to weight gain, so it's important to consider whether one is overeating or not exercising enough.
Dr.
Wu Enliang.

Reply Date: 2023/02/14

More Info

The long-term use of medications like Lexapro (escitalopram) and Prozac (fluoxetine) can indeed lead to weight changes, including weight gain, in some individuals. Both of these medications belong to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs), which are commonly prescribed for conditions such as depression, anxiety disorders, and obsessive-compulsive disorder (OCD).
Weight gain associated with SSRIs can vary significantly among individuals. Some people may experience an increase in appetite and subsequent weight gain, while others may not notice any significant changes in their weight. The mechanisms behind this weight gain are not entirely understood, but several factors may contribute:
1. Increased Appetite: SSRIs can affect neurotransmitters in the brain that regulate mood and appetite. For some individuals, this may lead to an increase in cravings for carbohydrates or other comfort foods, resulting in weight gain.

2. Fluid Retention: As you mentioned experiencing swelling, this could be a side effect of the medications. Some individuals report edema (fluid retention) while taking SSRIs, which can contribute to temporary weight gain.

3. Improved Mood: As symptoms of depression or anxiety improve with medication, individuals may find themselves more inclined to eat socially or indulge in foods they previously avoided, leading to weight gain.

4. Metabolic Changes: Some studies suggest that SSRIs may alter metabolism, although the exact nature of these changes is still being researched.

Regarding your experience with OCD and the incident at the massage parlor, it is possible that stressful or triggering situations can exacerbate symptoms of OCD. The nature of OCD often involves intrusive thoughts and compulsive behaviors, which can be triggered by anxiety-inducing experiences. The feelings of anger and frustration you described, combined with the inability to express those emotions, may have contributed to a resurgence of obsessive thoughts.
It's important to recognize that while medications can be effective in managing symptoms of OCD and anxiety, they are often most effective when combined with therapy, such as cognitive-behavioral therapy (CBT). CBT specifically addresses the thought patterns associated with OCD and can help you develop coping strategies for intrusive thoughts and compulsive behaviors.

If you are concerned about weight gain or other side effects from your medications, it is crucial to discuss these issues with your healthcare provider. They can help you assess the benefits and risks of your current treatment plan and may suggest alternatives or adjunct therapies to help manage your symptoms without significant weight gain.
In summary, while Lexapro and Prozac can lead to weight gain in some individuals, the experience varies widely. Factors such as increased appetite, fluid retention, and improved mood can all play a role. Additionally, stressful experiences can trigger OCD symptoms, and it's essential to address these concerns with a healthcare professional for a comprehensive treatment approach.

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