- Antidepressants are a common group of medications that help treat various mental health disorders.
- Physicians should consider potential side effects when prescribing specific antidepressants.
- A recent study highlighted weight changes associated with several antidepressants.
- Bupropion was associated with the least amount of weight gain, while antidepressants such as escitalopram and paroxetine were associated with the greatest weight gain.
All medications carry potential risks and sometimes unpleasant side effects. Doctors need to consider potential side effects and how these effects may affect outcomes such as treatment adherence.
Antidepressants are a group of medications commonly used to treat chronic mental health conditions, particularly serious illnesses. depressionSome reports have suggested that certain antidepressants may sometimes have weight gain as a side effect.
A study recently published in the journal Annals of Internal Medicine They examined weight changes associated with several common antidepressants.
Through their research, which included 183,118 participants, the study authors found that people taking bupropion (brand name Wellbutrin) were the least likely to experience weight gain, while participants who took escitalopram (Lexapro, Cipralex), paroxetine (Paxil, Seroxat), and duloxetine (Cymbalta) were the most likely to experience weight gain.
The results highlight the importance of discussing antidepressant side effects and medication adherence with people taking these medications.
This study was an observational cohort study that took place over two years. The researchers included 183,118 participants in their analysis and looked at the use of eight different common antidepressants.
They used prescription data from electronic health records to help collect information. They specifically focused on people who were new users of antidepressant medications and only included participants who had been prescribed an antidepressant medication.
The mean age of participants was 48 years. The researchers included participants between the ages of 20 and 80 who had no history of antidepressant use. They excluded participants who had a recent history of cancer, pregnancy or bariatric surgery.
The researchers analyzed weight measurements at the start of the study, at 6 months, at 1 year, and at 2 years after starting antidepressant medication.
The main outcome was to compare weight change after 6 months of antidepressant use compared with sertraline, a commonly prescribed antidepressant. The researchers also looked at weight changes after 1 and 2 years, and calculated the likelihood that participants would gain at least 5% of their initial weight.
In their analysis, they were able to adjust for covariates such as medication prescriptions that could also influence weight change, smoking status, and evidence of recent weight change.
The study found that the most commonly used medications among the group of participants were sertraline (Zoloft), citalopram (Celexa) and bupropion. Adherence to antidepressant use was 28% to 41% at 6 months, decreasing to 4% to 5% at 2 years.
According to their calculations, the researchers found that at 6 months, compared with sertraline, bupropion was associated with less weight gain. In contrast, escitalopram, duloxetine, paroxetine, venlafaxine (Effexor)and citalopram were associated with greater weight gain. Fluoxetine (Prozac) was similar to sertraline with respect to this side effect.
The researchers also estimated that escitalopram, paroxetine, and duloxetine each had a 10 to 15 percent increased risk of gaining 5 percent of initial weight or more.
Bupropion had a 15% reduction in the risk of gaining 5% of initial weight or more.
At 1 and 2 years, compared with sertraline, bupropion estimates for weight gain were even lower. Escitalopram was still associated with weight gain after 1 year, but not after 2 years. After 2 years, duloxetine and venlafaxine were associated with less weight gain than sertraline.
However, these estimates have limited precision due to low medication adherence.
Overall, the results highlight the possible need for weight changes to be part of conversations about antidepressant prescriptions.
Dr. Erich J. Conrad, FACLPprofessor of psychiatry at LSU Health New Orleans and director of the Behavioral Health Service Line at University Medical Center in New Orleans, who was not involved in this research, commented on the study’s findings. Today’s medical news.
He told us that:
“The results of this study support what was largely known from previous clinical trials and years of experience prescribing these medications. The large number of subjects in the study, over 183,000, is impressive. I think it is a good reminder to keep in mind the possibility of weight gain when considering prescribing this group of medications and to potentially use medications that are less likely to cause this side effect if clinically indicated and the best option for the patient.”
However, this research faces certain limitations that may have affected the results. First, the researchers lacked certain data that could have affected the results. For example, they did not have data on the dispensing of medicines.
Participants also had low medication adherence. The study authors also noted that they had incomplete data on adherence and weight measurements at different time points.
They acknowledged that they may have misclassified some participants as non-adherent due to missing data. There is also some risk of residual, baseline and time-varying confounding.
Low medication adherence reduced the accuracy of data from later time points because fewer participants were included. The research also did not look at dose-response effects.
Also, the study was observational, meaning it can’t prove a cause, such as that certain antidepressants cause weight gain or loss.
Again, while the researchers attempted to focus on first-time antidepressant users, it’s possible that some participants were not first-time users. Nearly 80% of participants were white and 65% were women, which could influence the generalizability of the results.
Furthermore, 15% to 30% of participants had weight measurements at exactly the 6-month, 1-year, and 2-year time points, and only 40% to 50% had weight measurements at one or more time points.
This could have affected the results of the study. Finally, some participants were prescribed additional antidepressants during the follow-up time, which could have affected the results.
Aarohee Desai-Gupta, MBBS, MRCPycologistA consultant psychiatrist, clinical director of the Atrom Mindcare Holistic Psychiatric Clinic, who was not involved in this study, expressed the view that any “direct clinical implications based solely on this research are minimal”.
“However,” he noted, “if individual patients experience weight gain with a SSRI [serotonin reuptake inhibitor]“Consideration should be given to modifying treatment to suit the specific circumstances and requirements of each individual, taking into account the results of this research.”
Groups of antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs).
Dr. Alex Dimitriudouble board-certified in psychiatry and sleep medicine and founder of Menlo Park Psychiatry & Sleep Medicine, who was not involved in the current study, offered more insight into antidepressants. MNT:
“Antidepressants are most often used to treat depression and anxiety, as they can significantly improve mood and energy, while reducing negative thoughts, obsessive thoughts, and rumination. It is thought that antidepressants may also work by increasing levels of BDNF (brain-derived neurotrophic factor). BDNF is like a miracle crop for neurons, which often means it can help people change old thought patterns and become more open to new ideas and perspectives, which can be helpful.”
The researchers who conducted the current study noted that weight gain is a common side effect of antidepressants.
Overall, they were interested in learning more about weight changes related to certain antidepressants and how these outcomes compare to each other, in the hope that these findings could help people receive better personalized care.
