Antidepressant drugs can be essential for improving mental health and well-being, but they often come with unwanted side effects, and one of the adverse effects of many psychiatric medications is weight gain. Now, Harvard scientists have conducted a study in which they have compared the data of 183,118 adults who had been treated with one of eight types of antidepressants and have revealed which ones are associated with the greatest weight gain, and which antidepressant is the least fattening. Their findings have been published in the Annals of Internal Medicine.
As Alberto Ortiz Lobo, Doctor of Medicine and psychiatrist at the Carlos III Day Hospital – La Paz University Hospital (Madrid) points out in statements to SMC Spain: “The prescription of antidepressants continues to increase year after year and around 10% of Spaniards are taking them,” adding that the fact that “a medication causes weight gain is a crucial issue because weight gain deteriorates physical health and quality of life, can lead to abandonment of treatment and also lower people’s self-esteem, something particularly important if we are talking about mental health.”
Association of antidepressant treatment with body weight gain
Researchers at Harvard Medical School and the Harvard Pilgrim Health Care Institute assessed medication-related weight changes in 183,118 patients at 6, 12, and 24 months after they began taking the drugs. The eight drugs studied were sertraline, citalopram, bupropion, escitalopram, fluoxetine, venlafaxine, paroxetine, and duloxetine. Differences in drug-induced weight gain were found among the different antidepressant subclasses.
Results showed that at 6 months, escitalopram, paroxetine, and duloxetine users gained 0.3 to 0.4 kg more weight and were 10 to 15 percent more likely to gain at least 5 percent of their initial weight than sertraline users. Bupropion users gained 0.22 kg less weight and were 15 percent less likely to gain at least 5 percent of their initial weight than sertraline users. Fluoxetine use was not associated with weight change at 6 months compared with sertraline use.
The researchers explained in their article that “they found small differences in mean weight change among 8 first-line antidepressants, with bupropion consistently showing the smallest weight gain, although medication adherence during follow-up was low,” so they believe that “physicians might consider possible weight gain when initiating antidepressant treatment.”
“Weight gain deteriorates physical health and quality of life, can lead to treatment abandonment and lower self-esteem, something particularly important if we are talking about mental health”
Dr. Ortiz Lobo also highlights the importance of taking into account the possible impact of the treatment on the patient’s well-being: “The importance of this research, beyond helping to choose the right antidepressant for those who need it, is that we can rethink the damage caused by its prescription and limit it to those people who will truly benefit from this treatment. A large part of common mental suffering can be resolved with social or psychological interventions, without the need for antidepressants, although this is the most frequent and immediate response. Finally, this study highlights the need to properly warn people who are going to take antidepressants of the adverse effects, such as weight gain in this case, and to consider the possibility of prescribing them through an informed consent document, as is usually done with surgical interventions and other treatments.”
Amelia Martí del Moral, PhD in Pharmacy, professor of Human Physiology at the University of Navarra, member of the CIBER Pathophysiology of Obesity, Carlos III Health Institute and IDISNA (Navarra), explained in statements to the same media: “these results are in line with a previous work by our group published in 2019 in which we conducted a systematic review aimed at evaluating the possible association of antidepressant and antipsychotic treatment with body weight gain in cohort studies. 27 independent eligible cohort studies with child subjects (2-18 years) and adults (18-103 years) were included. Most of the included studies showed a 5% weight gain in individuals using antidepressant therapy. However, quetiapine, haloperidol, trifluoperazine, risperidone, aripiprazole, olanzapine, and clozapine increased body weight ≥7% from baseline, which is considered a clinically significant outcome. Interestingly, weight loss was found in individuals treated with bupropion.”
