Eight common antidepressants ranked by potential for weight gain

Eight commonly used antidepressants are ranked according to their potential for weight gain.

Results of a large observational study showed small differences in short- and long-term weight change in patients prescribed one of eight antidepressants, with bupropion associated with the lowest weight gain and escitalopram, paroxetine, and duloxetine associated with the biggest.

Users of escitalopram, paroxetine and duloxetine were 10%-15% more likely to gain at least 5% of their initial weight compared to those taking sertraline, which was used as a comparator.

The investigators noted that the more clinicians and patients know about how a particular antidepressant may affect patients’ weight, the better informed they can be about which antidepressants to prescribe.

“Patients and their doctors often have several options when starting an antidepressant for the first time. This study provides important real-world evidence about the amount of weight gain to be expected after starting some of the most common antidepressants, ” lead author Joshua Petimar. , ScD, assistant professor of folk medicine at the Harvard Pilgrim Health Care Institute at Harvard Medical School, Boston, said in a news release.

The findings were published online on July 1 at Annals of internal medicine.

Real world data

Although weight gain is a commonly reported side effect of antidepressant use and can lead to medication non-adherence and worse outcomes, there is a lack of real-world data regarding weight change on specific medications.

The investigators used electronic health records from eight health care systems across the United States spanning from 2010 to 2019. The analysis included information on 183,118 adults aged 20-80 who were new users of a of eight common first-line antidepressants. The investigators measured their weight at baseline and at 6, 12, and 24 months after baseline to assess intention-to-treat (ITT) effects of weight change.

At baseline, participants were randomly assigned to start sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, or venlafaxine.

The most commonly prescribed antidepressants were sertraline, citalopram and bupropion. Approximately 36% of participants had a diagnosis of depression and 39% were diagnosed with anxiety.

Among selective serotonin reuptake inhibitors (SSRIs), escitalopram and paroxetine were associated with the greatest 6-month weight gain, while bupropion was associated with the least weight gain in all analyses.

Using sertraline as a comparator, 6-month weight change was lower for bupropion (difference, 0.22 kg) and higher for escitalopram (difference, 0.41 kg), duloxetine (difference, 0.34 kg), paroxetine (difference, 0.37 kg) and venlafaxine. (difference, 0.17 kg).

Users of escitalopram, paroxetine, and duloxetine were 10%–15% more likely to gain at least 5% of their baseline weight compared with sertraline users.

The researchers observed little difference in adherence rates between medications during the study, except at 6 months, when it was higher for those taking bupropion (41%) than for those taking other antidepressants (28%–36%). .

The study included data on prescriptions only, and the investigators could not verify whether medications were dispensed or taken as prescribed. Other limitations included the lack of information on weight because most patients did not meet with the health system exactly at 6, 12, and 24 months, only 15%–30% had weight measurements at those months.

Finally, low adherence rates made it difficult to attribute relative weight change at the 12- and 24-month time points to specific medications of interest.

“Clinicians and patients may consider these differences when making decisions about specific antidepressants, especially given the complex relationships of obesity and depression with health, quality of life, and stigma,” the authors write.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. The findings are noted in the original article.