Q. I've been on anti depressants for 10 years. About 2 years ago, Elavil was prescribed to me in conjunction with my Prozac. Consequently, I have gone from 140 lbs to 166 lbs. My depression is finally managed, but how do I now lose and manage my weight while still taking the antidepressants?

A.That is great that you have finally managed your depression. The bestway to start stimulating weight loss is to exercise at least 30 minutes fast walking or some type of structured exercise 5 times a week. That can be your goal. Start out slow and work up to it. In the meantime try to eliminate or limit all of the convenience, processed foods and snacks. Cut the sugar completely and get down to the basics for meals. Lean meats, fish, poultry, lots of vegetables, whole fruit (2 vegetables for every fruit), whole grains, beans, a variety of nuts, and seeds. Drink plenty of spring, mineral, or filtered water. Antidepressants need lots of water! It would be very helpful for you to keep your food records to start tracking the number of calories you are eating. The Pocket Personal Trainer is packed with information that will help motivate you, plan out your own meals, and exercise program. You could also calculate your daily calorie needs using the calculator on my website and can print out the menu planner PDF to plan your program.

Q. Thanks for your response. My fear is, particularly after reading your article on depression meds and weight gain, that somehow it is much more difficult to lose weight put on under those circumstances. What is your opinion on that? And, thank you for your advice, I will follow it.

A. It may be harder to exercise while taking antidepressant medication but in the long run you will feel much better. All you can do is try. Do not be discouraged. Drink plenty of water, exercise daily (brisk walking for 30 minutes), and avoid the obvious empty calories. Write down what you eat and how much you exercise. You will be able to see trends in your eating and behavior. This will help you identify the culprit foods that are contributing to your weight gain and you also will be able to see what your food intake should be to stimulate weight loss.

Q. My concerns are not with myself, but with my girlfriend who I am in love with. I am worried about her because she has gained quite a bit of weight in a very short time from Lexapro, and because of this she is extremely depressed and self-destructive. She hates everything about herself physically and is always angry due to her onset of depression! Please help me to find the best possible anti-depressant for her that will not make her gain the weight which is the root cause of her pain. She already tried Wellbutrin but, it did not help with her depression, even though it did not make her gain weight. Help me please.

A. Unfortunately I am not a psychiatrist or a physician so I cannot make medical recommendations. I would say if your girlfriend is still depressed, angry, and gaining weight, Lexapro may not be the right medication. Perhaps she needs some counseling and therapy to deal with whatever is making her unhappy. Is she exercising? I know the side affects of antidepressant medication can sometimes discourage exercise but that is the best way to stimulate the body's natural production of antidepressant neurotransmitters. A dietary key would be to avoid sugar and processed packaged foods particularly sweets and snacks that stimulate insulin and glucose or blood sugar sensitivity. Eating these foods can often cause hunger and overeating. More of a high protein, low sugar diet with plenty of vegetables, fruit, some whole grains, and nuts. Evening Primrose oil is an essential fatty acid that is a precursor to antidepressant type hormones called prostaglandins. Avoid NutraSweet. Another suggestion is to eat a varied diet on a 4 day rotation to avoid too much of one particular food. For example, chicken one day, beef another day, fish the next day, and pork the next day. Four different days of breakfast, oatmeal one day, toast and egg the next day, cream of wheat the next day, and peanut butter and rye bread the next day. The more varied, the cleaner the nutritional program the more able the body is to function at on optimal level. Is she on birth control of any kind? Women taking birth control often experience depression and need extra B vitamins, B12, B6 (a cofactor for the conversion of tryptophan to serotonin), and folic acid. If she is taking birth control she may want to supplement with these nutrients and that can help alleviate the depression. Other clinical considerations would be Hypothyroidism, food allergies, exposure to something toxic such as cigarette smoke, exhaust, latex, etc. I would definitely look for a health care professional that is knowledgeable about the various options for antidepressant medication as well as experienced with or connected to someone qualified to help your girlfriend deal with the root of her depression. A naturopathic or environmental physician might also be able to assist you. I hope this helps a little. Please feel free to contact me if there is something else I can help you with.

I hope this helped.  Please contact me for further information or if you have another question!