Weight Changes Caused by Common Antidepressant Medications

Recent findings comparing weight gain among eight different initial antidepressants reveal that individuals taking bupropion are 15-20% less prone to experiencing a clinically significant increase in weight compared to those taking sertraline, which is the most widely prescribed medication. The initial antidepressants are commonly known as first-line antidepressants. The results were published on July 2 in the journal Annals of Internal Medicine (1^✔ ✔Trusted Source
Medication-Induced Weight Change Across Common Antidepressant Treatments: A Target Trial Emulation Study

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Antidepressants are one of the most frequently prescribed drugs in the United States, with 14% of American adults disclosing using an antidepressant. One of the common side effects of these medications is weight gain. This effect of weight gain may impact the long-term metabolic well-being of patients and prompt some individuals to discontinue their prescribed medication, resulting in unfavorable clinical results. While antidepressants, in general, are linked to weight gain, certain antidepressant drugs could influence weight differently.

Antidepressant Medications and the Extent of Weight Gain

There is a very limited data available on the comparative weight change for the first-line antidepressant treatments.

The new study was conducted to show the effect of common antidepressants on the highest and lowest weight gain after starting the medication. The study was conducted by researchers from the Harvard Pilgrim Health Care Institute.

The lead author Joshua Petimar, Harvard Medical School assistant professor of population medicine at the Harvard Pilgrim Health Care Institute said, “Patients and their clinicians often have several options when starting an antidepressant for the first time. This study provides important real-world evidence regarding the amount of weight gain that should be expected after starting some of the most common antidepressants.”

Petimar further added, “Clinicians and patients can use this information, among other factors, to help decide on the right choice for them.”

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The study experts utilized electronic health record prescription information from eight U.S. health systems involved in PCORnet, the National Patient-Centered Clinical Research Network, for the study. The study involved analyzing data from 183,118 adults aged 18-80 years who were new users of antidepressants. Randomized control trials are typically seen as the most rigorous approach for comparing medication effects, but they are expensive and time-consuming. In this instance, the study team simulated a randomized trial by creating an ideal hypothetical trial and aligning the data to closely match that trial.

The study experts conducted a comparison of weight changes at 6, 12, and 24 months following the start of treatment with eight widely used antidepressants: sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, and venlafaxine.

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The findings indicated that individuals using bupropion experienced the least increase in weight compared to those using other antidepressants. Bupropion users had a 15-20% lower likelihood of gaining a clinically significant amount of weight compared to individuals taking the most widely used medication, sertraline. The researchers defined a clinically significant weight gain as 5% or more. The results also revealed that a large proportion of patients were prescribed a medication that resulted in greater weight gain compared to other commonly available alternatives within the same class or subclass. For instance, while sertraline, escitalopram, and paroxetine are all selective serotonin reuptake inhibitors (SSRI), the most common type of antidepressant, both escitalopram and paroxetine were linked to an approximately 15% higher risk of gaining a clinically significant amount of weight in the first 6 months compared to sertraline.

The senior author Jason Block, a general internal medicine physician and Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute said, “Although there are several reasons why patients and their clinicians might choose one antidepressant over another, weight gain is an important side effect that often leads to patients stopping their medication.”

Block further added, “Our study found that some antidepressants, like bupropion, are associated with less weight gain than others. Patients and their clinicians could consider weight gain as one reason for choosing a medication that best fits their needs.”

It is important to bear in mind that the response to antidepressants can differ from person to person, and it is crucial to talk to your healthcare provider about any concerns regarding weight.

Reference:

1. Medication-Induced Weight Change Across Common Antidepressant Treatments: A Target Trial Emulation Study - (https://www.acpjournals.org/doi/10.7326/M23-2742)

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