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June 18, 2014
Some Antidepressants Linked to More Weight Gain
Than Others

Boston—Questions and concerns about weight gain are common among patients filling prescriptions for antidepressants. Now, pharmacists have some useful new information to offer.

A study lead by researchers from Massachusetts General Hospital in Boston has found that antidepressants are not all the same when it comes to promoting weight gain in users.

Background in the article notes previous research suggesting an association between antidepressant use and weight gain, pointing out those health consequences “could be significant because more than 10% of Americans are prescribed an antidepressant at any given time. Obesity is associated with a host of medical conditions, including cardiovascular disease, type 2 diabetes and high blood pressure.”

For the study, researchers reviewed electronic health records from a large New England health care system, collecting prescribing data and recorded weights for adult patients aged 18 to 65 years who were prescribed one of 11 common antidepressants.

Comparing 19,244 adults treated with an antidepressant for at least 3 months to 3,366 who did not take the drugs, the authors found meaningful differences in the trajectory of weight gain for multiple antidepressants. Most notably, patients using bupropion and the tricyclic antidepressants nortriptyline and amitriptyline demonstrated significantly less weight gain than citalopram, according to the study.

The authors note that selective serotonin re-uptake inhibitors were similar in rate of weight gain; escitalopram, the S enantiomer of citalopram, did not show much difference from the racemic mixture. Although the difference did not rise to statistical significance, the serotonin-norepinephrine reuptake inhibitors, particularly duloxetine, also yielded somewhat less weight gain than citalopram, the authors add.

Products reviewed included amitriptyline hydrochloride, bupropion hydrochloride, citalopram hydrobromide, duloxetine hydrochloride, escitalopram oxalate, fluoxetine hydrochloride, mirtazapine, nortriptyline hydrochloride, paroxetine hydrochloride, venlafaxine hydrochloride, and sertraline hydrochloride.

“Taken together, our results clearly demonstrate significant differences between several individual antidepressant strategies in their propensity to contribute to weight gain,” the authors conclude. “While the absolute magnitude of such differences is relatively modest, these differences may lead clinicians to prefer certain treatments according to patient preference or in individuals for whom weight gain is a particular concern.”

Being younger and male were both associated with greater weight gain across treatment modalities, according to the study, which added that general medical features linked with greater weight gain included lower baseline BMI and weight loss prior to treatment initiation. In addition, patients with anxiety or depression diagnoses and those receiving concomitant antipsychotic treatment were found to be at higher risks of putting on the pounds.

Pointing out that the study includes tables that can be used to estimate absolute weight gain, the authors urge prescribers to discuss weight issues with patients. They also called for more clinical trials to be conducted to further explore the issue.

“In light of the marked elevation in mortality observed with depressive and related disorders, interventions to diminish weight gain merit further investigation,” they add. “More broadly, this study illustrates the role of electronic health records investigations to systematically detect and quantify adverse effects, complementing traditional approaches including randomized trials, meta-analysis, and post-marketing surveillance.”





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