New help weighing up antidepressants

I have a cousin who has suffered from depression for years. Like many in her position, she’ll go through a period when things are OK, during which time she might stop taking her medication; never a good idea.

As a consequence, she’s sampled lots of different antidepressants, with doctors using her lack of compliance to try on different drugs to see which one will suit her best.

From time to time, she complains that her medication is making her put on weight, which greatly adds to her burden – as one who is under the delusion that her worth is linked to her appearance, you can understand why. Sadly, she is not alone.

Studies to date do, indeed, suggest that antidepressants are associated with weight gain, but little is known about the long-term effects and the differences between various types of medication.

A recent study in JAMA Psychiatry offers a little more clarity on this issue, showing that there are small, but significant differences between the level of weight gain associated with different types of antidepressant.

The researchers, in Boston, used digital health records to obtain prescribing data and body weight measurements for adults who had been prescribed eleven different antidepressants. Over 22,000 patient records were analysed over 12 months, and antidepressants ranged from the older types, amitripyline for example, to the more modern SSRIs and SNRIs.

The results showed that there was a modest difference in weight gain between patients taking different drugs. Of note, there was significantly lower weight gain on bupropion, amitriptyline (widely believed to contribute to weight gain) and nortriptyline, compared to citalopram (Cipralex – 2.5 pound gain on average), fluoextine (Prozac – 1.5 pound gain on average) and sertraline (Zoloft – nearly 2 pound gain on average).

The authors concluded:

“Taken together, our results clearly demonstrate significant differences between several individual antidepressant strategies in their propensity to contribute to weight gain. 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.” 

This is good news for my cousin, who resists the suggestion of talk therapy (and therefore might reasonably be expected to remain on medication for the foreseeable future) and has recently been diagnosed with hypertension. She might now be prescribed for in accordance with her clinical risk and preference for weight maintenance.

Written by Jacqui Hogan