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If you’re struggling with depression, the most important question about taking an antidepressant is whether it will work. But another question on your mind may be whether it will fuel weight gain.

A new study provides some context by suggesting how much weight, on average, people taking one of eight commonly used antidepressants might expect to gain. This insight is valuable, since people with depression often stop taking antidepressants because they don’t like the effect on their weight, a Harvard expert says.

“It’s important to acknowledge that weight gain is a key reason that some people decide to stop antidepressants, even if they’re otherwise working well,” says Dr. Roy Perlis, associate chief of psychiatric research at Massachusetts General Hospital. “It’s also a reason people may be reluctant to start them in the first place, even if they’re quite depressed or anxious.”

What did the study look at?

Published July 2024 in Annals of Internal Medicine, the new study drew on data from more than 183,000 people between ages 20 and 80. Their average age was 48, and 65% were women. Most were overweight or obese at the study’s start.

The researchers analyzed participants’ electronic health records and body mass index. They gauged weight gain or loss at regular intervals — six, 12, and 24 months — after people began taking an antidepressant for the first time.

The study compared the weight-related effects of sertraline (Zoloft) to seven other antidepressant medications:

• escitalopram (Lexapro)
• paroxetine (Paxil)
• duloxetine (Cymbalta)
• citalopram (Celexa)
• fluoxetine (Prozac)
• venlafaxine (Effexor)
• bupropion (Wellbutrin).

What did the research find?

The antidepressants led to the following average weight gain:

• sertraline: Nearly 0.5 pounds at six months; 3.2 pounds at 24 months
• escitalopram: 1.4 pounds at six months; 3.6 pounds at 24 months
• paroxetine: 1.4 pounds at six months; 2.9 pounds at 24 months
• duloxetine: 1.2 pounds at six months; 1.7 pounds at 24 months.

Citalopram, fluoxetine, and venlafaxine didn’t confer lower or higher odds of weight gain than Zoloft, the study found. And only bupropion was associated with a small amount of weight loss — 0.25-pounds — at six months. But that trend reversed at 24 months, when bupropion led to an average weight gain of 1.2 pounds.

What does the study tell us?

“Weight gain is common among antidepressant users, even if the amounts gained on average are modest,” says Dr. Perlis, who was not involved in this new study. It underscores similar findings from other studies of antidepressants, including research he published with colleagues a decade ago.

“While differences in weight gain for specific antidepressants tend to be small, there are certainly some — like bupropion — that tend to cause less weight gain,” he notes.

It’s crucial to keep in mind that the study points out average weight gain. Many people taking antidepressants won’t gain any weight and others could gain more. “Still, having average values to work with — and seeing that these averages line up well with prior studies — at least lets us give people a sense of what they might expect,” he says.

“One caution is that some people lose weight as a result of depression, which can impact appetite,” he adds, “so some of what we’re seeing may be people regaining weight they’d lost as their depression or anxiety improves.”

What additional limitations did the study have?

Other limitations may have shaped the findings. The study was observational, meaning it cannot prove that antidepressants cause weight changes, only that they were linked with them. It wasn’t a randomized, controlled trial — considered the gold standard in research — and the participants taking antidepressants weren’t compared to a control group not taking the medications.

Additionally, only about one in three participants was still taking their initially prescribed medication six months after the study started. That makes it difficult to link any later weight changes with a specific medication.

“As with any study that’s not randomized, we don’t know if the differences between medicines could reflect other differences in who gets prescribed these medicines,” Dr. Perlis says. “But, for circumstances where a randomized trial is unrealistic, health records can be a helpful way of trying to study side effects and at least generate a partial answer to these important questions.”

What else should you consider?

Another thing to consider, if you’re taking an antidepressant, is what types of side effects you’re willing to tolerate in pursuit of its mood-smoothing benefits.

“The best way to manage side effects is to anticipate them — to have an open conversation with your doctor about the potential risks and how we’ll manage them if they occur,” Dr. Perlis says.

What can you discuss with your doctor?

If weight gain is a particular concern for you, you may also wish to consider nondrug treatments for depression. They include:

• Cognitive behavioral therapy (CBT), a type of psychotherapy that teaches people to become aware of their thought patterns and adjust them during stressful moments to reframe their thinking.
• Repetitive transcranial magnetic stimulation (rTMS), a brain stimulation therapy that is noninvasive. It uses an electromagnetic coil placed on the scalp to deliver magnetic pulses that stimulate nerve cells to brain regions involved in depression.

“We know that certain kinds of talk therapies, especially cognitive behavioral therapy, can be very effective for treating depression and anxiety disorders,” Dr. Perlis says. “Whether people choose talk therapy or antidepressant medications can depend on their preference. It’s important to have multiple options.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Several evenings a week, as Tyler VanderWeele gathers around the dinner table with his wife and two young kids, the family deliberately pauses during the meal to do something simple but profound. Each member shares several things for which they’re grateful — an act that VanderWeele, co-director of the Initiative on Health, Spirituality, and Religion at the Harvard T.H. Chan School of Public Health, feels changes his family dynamic for the better.

“I do think it makes a difference and can be a very powerful practice,” he says. “Even on those bad days where life seems difficult, that effort is worthwhile.”

Gratitude, health, and longevity

How can the power of gratitude affect our lives? Recent research has pointed to gratitude’s myriad positive health effects, including greater emotional and social well-being, better sleep quality, lower depression risks, and favorable markers of cardiovascular health. Now, new data from the long-term Nurses’ Health Study shows that it may extend lives.

“Gratitude has been one of the most widely studied activities contributing to well-being, but we couldn’t find a single prior study that looked at its effects on mortality and longevity, much to our surprise,” says VanderWeele, co-author of the new research.

What did the study look at?

Published July 2024 in JAMA Psychiatry, the new study drew on data from 49,275 women enrolled in the Nurses’ Health Study. Their average age was 79. In 2016, participants completed a six-item gratitude questionnaire in which they ranked their agreement with statements such as, “I have so much in life to be thankful for,” and “If I had to list everything I felt grateful for, it would be a very long list.”

Four years later, researchers combed through participants’ medical records to determine who had died. There were 4,608 deaths from all causes, as well as from specific causes such as cardiovascular disease, cancer, respiratory diseases, neurodegenerative disease, infection, and injury. Deaths from cardiovascular disease — a top killer of women and men in the United States — were the most common cause.

What did the researchers find?

Participants with gratitude scores in the highest third at the study’s start had a 9% lower risk of dying over the following four years than participants who scored in the bottom third. This did not change after controlling for physical health, economic circumstances, and other aspects of mental health and well-being. Gratitude seemed to help protect participants from every cause of death studied — including cardiovascular disease.

But what does this actually mean?

“A 9% reduction in mortality risk is meaningful, but not huge,” VanderWeele says. “But what’s remarkable about gratitude is that just about anyone can practice it. Anyone can recognize what’s around them and express thanks to others for what’s good in their life.”

While the study couldn’t pinpoint why gratitude is associated with longer life, VanderWeele believes several factors may contribute.

“We know that gratitude makes people feel happier. That in itself has a small effect on mortality risk,” he says. “Practicing gratitude may also make someone a bit more motivated to take care of their health. Maybe they’re more likely to show up for medical appointments or exercise. It may also help with relationships and social support, which we know contribute to health.”

What are the study’s limitations and strengths?

The study was observational. This means it can’t prove that gratitude helps people live longer — only that an association exists. And the particular sample of people analyzed is both the biggest strength and limitation of the research, VanderWeele says. All were older female nurses with high socioeconomic status. The vast majority were white.

“Does the longevity effect extend to men, to those who are younger, and to those with lower socioeconomic resources?” VanderWeele asks. “Those are all open questions.”

On the plus side, he says, the study sample’s large size is one of its biggest strengths. So is the extensive data gathered on potential confounding factors such as participants’ physical health, social characteristics, and other aspects of psychological well-being.

“Between the quality of the data and the size of the sample, we were able to provide reasonable evidence for this modest longevity effect,” he says.

Try this: Six questions to evoke gratitude

Not feeling especially grateful today? You have the power to change that. Asking yourself certain questions can evoke gratitude, such as

• What happened today that was good?
• What am I taking for granted that I can be thankful for?
• Which people in my life am I grateful for?
• What is the last book I read or movie, show, or social media clip I saw that I really appreciated, and why?
• What am I most looking forward to this week, month, and year, and why?
• What is the kindest thing someone has said or done lately?

Similarly, a few simple actions can infuse gratitude into your days. Try VanderWeele’s family routine of regularly expressing gratitude around the dinner table. Another well-known practice — that’s perhaps becoming forgotten in this digital age — is penning thank-you notes.

“I do think writing a thank-you note or gratitude letter gets your mind to dwell on something positive for a longer period, to think more deeply about it, because you have to put it not just in words, but in writing,” VanderWeele says. “It also deepens the relationship and builds that bond.”

One less-recognized but valuable gratitude practice is called a “savoring exercise,” which builds on aspects of mindfulness. All that’s required is “pausing, looking around you, and taking in and enjoying everything that’s good in your current setting,” VanderWeele says. “It’s not a big leap to go from recognizing the good to expressing gratitude for what you have.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Trees enhance life in a multitude of ways. They combat climate change by reducing greenhouse gases in the atmosphere. They muffle sound pollution and reduce air pollution, drawing in carbon dioxide and releasing oxygen. When rain pours from the skies, trees decrease stormwater runoff, preventing flooding and soil erosion. They also provide valuable habitats to support biodiversity in insects, birds, and other animals, and microorganisms. The list goes on.

Equally important is accumulating evidence that simply spending time around trees and green spaces uplifts our health and mood. Below are a few of the biggest benefits we reap.

Keeping it cool: Trees help prevent heat-related illness

Climate change is causing rising temperatures and more heat waves across the US. These effects are worse for those who live in neighborhoods known as urban heat islands, where asphalt and concrete soak up heat during the day and continue to radiate it at night. Temperatures can reach 7° F hotter than suburban, rural, or simply wealthier and leafier neighborhoods.

Trees and their leafy canopy provide shade that helps to prevent urban heat islands. What does that mean for individuals? It translates to fewer heat-related health illnesses, which strike outdoor workers and younger, older, and medically vulnerable people more often. A study published in The Lancet calculated that increasing tree canopy to 30% coverage in 93 European cities could prevent an estimated four in 10 premature heat-related deaths in adults in those cities.

How trees help children: Better mood, behavior, attention, and more

Spending more time in nature has been linked with better health outcomes like lower blood pressure, better sleep, and improvement in many chronic conditions in adults. These findings are prompting a growing interest in forest therapy, a guided outdoor healing practice that leads to overall improved well-being. But what’s also remarkable are the varied benefits of trees and nature for children.

One study of children 4 to 6 years old found that those who lived close to green space demonstrated less hyperactive behavior and scored more highly on attention and visual memory testing measures compared with children who did not.

Just seeing trees can have mental health benefits. In Michigan, a study of children between the ages of 7 and 9 demonstrated that students who could see trees from their school windows had fewer behavioral problems than those with limited views.

In Finland, researchers modified daycare outdoor playscape environments to mimic the forest undergrowth. These daycares were compared to control standard daycares and nature-oriented daycares where children made daily visits to nearby forests. At the end of 28 days, the children in the daycares with modified forest undergrowth playscapes harbored a healthier microbiome and had improved markers of their immune systems as compared to their counterparts.

How green space helps communities

Having green space in neighborhoods also does a lot to enrich the well-being of communities. A randomized trial in a US city planted and maintained grass and trees in previously vacant lots. Researchers then compared these green spaces to lots that were left alone.

In neighborhoods below the poverty line, there was a reduction in crime for areas with greened lots compared to untouched vacant lots. Meanwhile, residents who lived near lots that were greened reported feeling safer and increased their use of the outside space for relaxing and socializing.

How can you help?

Unfortunately, urban tree canopy cover has been declining over the years. To counter this decline, many towns and nonprofit organizations have programs that provide trees for planting.

A few examples in Massachusetts are Canopy Crew in Cambridge and Speak for the Trees in Boston. (Speak for the Trees also offers helpful information on selecting and caring for trees). Neighborhood Forest provides trees for schools and other youth organizations across the US. Look for a program near you!

Planting trees native to your region will better suit the local conditions, wildlife, and ecosystem. Contact your regional Native Plant Society for more information and guidance. If you are worried about seasonal allergies from tree pollen, many tree organizations or certified arborists can give you guidance on the best native tree selections.

If planting trees is not for you but you are interested in contributing to the mission, consider donating to organizations that support reforestation, like The Canopy Project and the Arbor Day Foundation.

About the Author

Wynne Armand, MD, Contributor

Dr. Wynne Armand is a physician at Massachusetts General Hospital (MGH), where she provides primary care; an assistant professor in medicine at Harvard Medical School; and associate director of the MGH Center for the Environment and … See Full Bio View all posts by Wynne Armand, MD