Which Antidepressant Gains the Least Weight When Taken Together?

 According to new research, out of eight first-line antidepressants, bupropion consistently showed the least amount of weight gain.

The mean weight change of eight first-line antidepressants varied little, according to a target trial emulations study; bupropion consistently exhibited the least amount of weight gain, however medication adherence throughout follow-up was poor.1, 2

When beginning an antidepressant for the first time, patients and their doctors frequently have a number of options. Joshua Petimar, the study's lead author and assistant professor of population medicine at the Harvard Pilgrim Health Care Institute, stated that the research "provides important real-world evidence regarding the amount of weight gain that should be expected after starting some of the most common antidepressants." "This information, along with other considerations, can assist clinicians and patients in making the best decision for themselves."3.

Researchers from Harvard Pilgrim Health Care Institute and Harvard Medical School examined electronic health records of over 183,000 adults who began treatment with one of eight first-line antidepressants in order to measure changes in weight by medication at six, twelve, and twenty-four months after the participants started taking it. Sertraline, citalopram, bupropion, escitalopram, fluoxetine, venlafaxine, paroxetine, and duloxetine were the eight drugs that were the subject of the study. The antidepressant that each participant was started on was identified by their prescription information. Then, in comparison to sertraline, the researchers calculated the population-level effects of starting each therapy on mean weight change (primary) and the likelihood of gaining at least 5% of baseline weight (secondary) six months after starting.

Next, in order to take baseline confounding and informative outcome measurement into account, they employed inverse probability weighting of repeated outcome marginal structural models. Secondary analyses were used to determine the impact of starting each treatment procedure and following it through.

The researchers observed variations in weight gain brought on by treatment within and between antidepressant subclasses. Escitalopram (difference, 0.41 kg [95% CI, 0.31 to 0.52 kg]), paroxetine (difference, 0.37 kg [CI, 0.20 to 0.54 kg]), duloxetine (difference, 0.34 kg [CI, 0.22 to 0.44 kg]), venlafaxine (difference, 0.17 kg [CI, 0.03 to 0.31 kg]), and citalopram (difference, 0.12 kg [CI, 0.02 to 0.23 kg]) were all estimated 6-month weight gain when compared to sertraline. Compared to sertraline users, bupropion users gained 0.22 kg less weight and had a 15% lower chance of gaining at least 5% of their baseline weight.

When compared to sertraline use, the 6-month weight change was not linked to the use of fluoxetine. Duloxetine, paroxetine, and escitalopram were linked to a 10% to 15% increased chance of gaining at least 5% of one's starting weight. Stronger but wider confidence intervals were seen in the connections when the effects of initiation and adherence were evaluated. Duloxetine had a 6-month adherence rate of 28%, while bupropion had a 41% rate. The research article appears in the Annals of Internal Medicine.1.

"Weight gain is a significant side effect that frequently results in patients stopping their medication, even though there are several reasons why patients and their clinicians might choose one antidepressant over another," stated Jason Block, the study's senior author, a general internal medicine physician and associate professor of population medicine at the Harvard Pilgrim Health Care Institute. According to our research, certain antidepressants—like bupropion—are linked to a lower risk of weight gain than others. Weight gain may be taken into account by patients and their doctors when selecting the right medication.3.

When starting patients on antidepressant treatment, doctors should take prospective weight gain into consideration as it may affect medication adherence.

References:

Yu H, Young JG, Petimar J, et al. Medication-induced weight change during standard antidepressant treatment: an emulation study based on target trials. J Intern Med. 2024; 2 Jul. Prior to print, online.

2. When starting antidepressant treatment, medication selection may have an impact on weight gain. American Medical College. Press release. 1 July 2024. obtained on July 3, 2024. News-releases/1049459 at https://www.eurekalert.org

3. Variations in weight with typical antidepressants. Pilgrim Health Care Institute at Harvard. Press release. 1 July 2024. obtained on July 3, 2024. 1049472 through https://www.eurekalert.org/news-releases