Depression: Patients with depression who are taking selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) should avoid serotonin receptor agonists such as lorcaserin, which can potentially trigger serotonin syndrome.24-28 Some antidepressants are associated with weight gain – especially amitriptyline and mirtazapine – while bupropion and fluoxetine are associated with weight loss.29,30

Psychosis: Of the antipsychotic therapies, ziprasidone is associated with the least weight gain, while olanzapine and clozapine are associated with the greatest weight gain.31-34

Epilepsy: Antiepileptic drugs (AEDs) associated with weight loss are felbamate, topiramate, and zonisamide; those associated with weight gain are gabapentin, pregabalin, valproic acid, vigabatrin, and carbamazepine. Lamotrigine, levetiracetam, and phenytoin are weight-neutral.35


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Contraception: In women with BMI >27kg/m2 with comorbidities, or BMI >30kg/m2, oral contraceptives are preferable to injectables. Recent evidence suggests that oral contraceptives are not associated with weight gain.36

HIV: Patients receiving antiretroviral therapy should receive weight and waist circumference monitoring, due to unavoidable weight gain, weight distribution, and associated cardiovascular risk.37

Rheumatoid arthritis: Since corticosteroids commonly produce weight gain, patients with rheumatoid arthritis should use nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs) when possible.38

Antihistamines with less central nervous system activity are preferable; the more potent the antihistamine, the greater the potential for weight gain.39