Small Differences in Weight Change With First-Line Antidepressants

2024-07-01

MONDAY, July 1, 2024 -- For eight first-line antidepressants, small differences are seen in mean weight change, with the least weight gain with bupropion, according to a study published online July 2 in the Annals of Internal Medicine.

Joshua Petimar, Sc.D., from Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston, and colleagues conducted an observational cohort study over 24 months to compare weight change across common first-line antidepressant treatments using electronic health record data for 183,118 patients. Initiation of treatment with sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, or venlafaxine was ascertained using prescription data.

The researchers found that the estimated six-month weight gain was higher for escitalopram, paroxetine, duloxetine, venlafaxine, and citalopram than sertraline (differences, 0.41, 0.37, 0.34, 0.17, and 0.12 kg, respectively), was similar for fluoxetine (difference, −0.07 kg), and was lower for bupropion (difference, −0.22 kg). A 10 to 15 percent higher risk for gaining at least 5 percent of baseline weight was seen for escitalopram, paroxetine, and duloxetine, while a 15 percent reduced risk was seen for bupropion. Associations were stronger, with wider confidence intervals, when the effects of initiation and adherence were estimated. There was variation seen in six-month adherence, from 28 to 42 percent for duloxetine and bupropion, respectively.

"Clinicians and patients could consider these differences when making decisions about specific antidepressants, especially given the complex relationships of obesity and depression with health, quality of life, and stigma," the authors write.

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