A recent study examined how weight changes vary among eight commonly prescribed first-line antidepressants for individuals starting antidepressant treatment. The research uncovered differences in weight changes among these medications, with bupropion consistently resulting in the least amount of weight gain after starting treatment. This study contributes valuable evidence on the expected weight gain associated with various commonly used antidepressants.
A recent study comparing weight gain among users of eight different first-line antidepressants revealed that individuals taking bupropion are 15-20% less likely to experience a clinically significant increase in weight compared to those taking sertraline, which is the most frequently prescribed medication.
The study outcomes were released on July 2 in Annals of Internal Medicine.
Antidepressants are one of the most commonly prescribed medications in the United States, with 14% of American adults reporting antidepressant use. Weight gain is a prevalent side effect of these medications, which can impact patients’ long-term metabolic health and may lead some individuals to discontinue their prescribed treatment, resulting in unfavorable clinical outcomes. Although antidepressants, in general, are linked to weight gain, specific antidepressant medications may influence weight changes differently.
This recent research, led by investigators from the Harvard Pilgrim Health Care Institute, sheds light on which common antidepressants are associated with the highest and lowest weight gain following the initiation of medication.
“When starting an antidepressant for the first time, patients and their healthcare providers often have multiple options to choose from. This study offers crucial real-world insights into the expected amount of weight gain with some of the most commonly prescribed antidepressants,” stated lead author Joshua Petimar, who is an assistant professor of population medicine at Harvard Medical School and affiliated with the Harvard Pilgrim Health Care Institute. “By considering this information, along with other factors, clinicians and patients can make informed decisions about the most suitable treatment.”
Researchers utilized prescription data from electronic health records across eight healthcare systems in the U.S. participating in PCORnet, the National Patient-Centered Clinical Research Network, to conduct the study involving 183,118 adults aged between 18 and 80 years who were new users of antidepressants. While randomized controlled trials are deemed the most rigorous approach for comparing the effects of different medications, they are often expensive and time-consuming. In this instance, the study team simulated a randomized trial by devising an ideal hypothetical trial and aligning the data as closely as possible to resemble that trial.
The study compared the weight changes at 6, 12, and 24 months after starting eight common antidepressants: sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, and venlafaxine.
The results indicated that individuals using bupropion experienced the lowest amount of weight gain compared to users of other antidepressants. Those taking bupropion were around 15-20% less likely to gain a clinically significant amount of weight than individuals using the most prevalent medication, sertraline. The researchers classified a weight gain of 5% or more as clinically significant. Additionally, a considerable proportion of patients were prescribed a medication associated with greater weight gain than alternative options within the same class or subclass that are widely available. For example, sertraline, escitalopram, and paroxetine belong to the selective serotonin reuptake inhibitor (SSRI) class, the most common type of antidepressants. However, in the initial 6 months, escitalopram and paroxetine each were linked to approximately 15% higher chances of gaining a clinically significant amount of weight compared to sertraline.
“While there are various reasons why patients and their healthcare providers may opt for one antidepressant over another, weight gain is a significant side effect that frequently leads to patients discontinuing their medication,” mentioned senior author Jason Block, who is a general internal medicine physician and an associate professor of population medicine at Harvard Medical School affiliated with the Harvard Pilgrim Health Care Institute. “Our study identified that certain antidepressants, such as bupropion, are linked to less weight gain than others. Patients and healthcare providers may consider weight gain as a critical factor in selecting a medication that best aligns with their needs.”
