That is a question addressed in a new study from Harvard T.H. Chan School of Public Health in Boston. The authors pointed out, “Antidepressants are among the most commonly prescribed medications, but evidence on comparative weight change for specific first-line treatments is limited.”
With results published in Annals of Internal Medicine, the researchers sought to compare weight change across common first-line antidepressant treatments by emulating a target trial.
The researchers conducted an observational cohort study of 183,118 patients over 24 months, using electronic health record data from 2010 to 2019 across eight U.S. health systems.
The study analyzed prescription data to determine initiation of treatment with sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, or venlafaxine.
The population-level effects of initiating each treatment, relative to sertraline, on mean weight change (primary) and the probability of gaining at least 5% of baseline weight (secondary) 6 months after initiation was calculated.
Compared with sertraline, the results indicated that estimated 6-month weight gain was higher for escitalopram (difference, 0.41 kg [95% CI, 0.31-0.52 kg]); paroxetine (difference, 0.37 kg [95% CI, 0.20-0.54 kg]); duloxetine (difference, 0.34 kg [95% CI, 0.22-0.44 kg]); venlafaxine (difference, 0.17 kg [95% CI, 0.03-0.31 kg]); and citalopram (difference, 0.12 kg [95% CI, 0.02-0.23 kg]). Weight gain was similar for fluoxetine (difference, –0.07 kg [95% CI, –0.19 to 0.04 kg]) and lower for bupropion (difference, –0.22 kg [95% CI, –0.33 to –0.12 kg]).
“Escitalopram, paroxetine, and duloxetine were associated with 10% to 15% higher risk for gaining at least 5% of baseline weight, whereas bupropion was associated with 15% reduced risk,” the authors pointed out. “When the effects of initiation and adherence were estimated, associations were stronger but had wider CIs. Six-month adherence ranged from 28% (duloxetine) to 41% (bupropion).”
The study did not include data on medication dispensing or low medication adherence and had incomplete information on adherence and weight measures across time points, according to the authors.
“Small differences in mean weight change were found between eight first-line antidepressants, with bupropion consistently showing the least weight gain, although adherence to medications over follow-up was low,” the researchers advised. “Clinicians could consider potential weight gain when initiating antidepressant treatment.”
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