Eight Common Antidepressants Ranked by Weight Gain Potential

Title: Weight Gain Potential of Commonly Used Antidepressants Ranked in a Large Observational Study

A study published in Annals of Internal Medicine has ranked eight common antidepressants according to their weight gain potential. The results indicate that bupropion is associated with the least weight gain, while escitalopram, paroxetine, and duloxetine were found to cause the most significant weight increases.

Key Findings:
Investigators used data from eight healthcare systems across the United States covering a period from 2010 to 2019. The study involved 183,118 adult patients who were new users of one of the eight common first-line antidepressants. The weight of each patient was measured at baseline and at 6, 12, and 24 months following the initiation of the medication to estimate the intention-to-treat effects of weight change.

Among Selective Serotonin Reuptake Inhibitors (SSRIs), escitalopram and paroxetine were associated with the most considerable 6-month weight gain, whereas bupropion was linked to the least weight gain across all analyses. After comparing with sertraline, the comparator used in the study, 6-month weight change was lower for bupropion (0.22 kg), and higher for escitalopram (0.41 kg), duloxetine (0.34 kg), paroxetine (0.37 kg), and venlafaxine (0.17 kg).

It was also found that escitalopram, paroxetine, and duloxetine users were 10%-15% more likely to gain at least 5% of their baseline weight compared with sertraline users.

Limitations and Limitations:
The study has its limitations, including the inability to confirm whether the medications were dispensed or taken as prescribed, missing weight information since most patients did not encounter the health system at exactly 6, 12, and 24 months, and the fact that only 15%-30% had weight measurements in those months. Another limitation was the low adherence rates, which made it difficult to attribute the weight change at the 12- and 24-month time points to the specific medications of interest.

Patients and clinicians should take the observed differences in weight gain potential when deciding on specific antidepressants, especially considering the complex relationships between obesity, depression, health, quality of life, and stigma. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

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