Bupropion Shows Lowest Risk of Weight Gain Compared to Other Antidepressants
Though weight gain is a common side effect of many antidepressants, bupropion may pose the least risk of weight gain for patients with major depressive disorder (MDD), according to results from an observational cohort study published in Annals of Internal Medicine.
“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,” noted lead author Joshua Petimar, ScD, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, and co-authors.
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Researchers used electronic health record (EHR) data from 2010 to 2019 across 8 United States health systems to examine initiation of 8 antidepressants: sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, and venlafaxine. Population-level effects of each treatment were estimated 6 months after initiation. To account for baseline confounding and informative outcome measurement, researchers used inverse probability weighting of repeated outcome marginal structural models. The primary measure investigated was mean weight change and the secondary measure was the probability of gaining at least 5% of baseline weight.
Of 183,118 patients, compared with sertraline, estimated 6-month weight gain was higher for 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]), venlafaxine (difference, 0.17 kg [CI, 0.03 to 0.32 kg]), and citalopram (difference, 0.12 kg [CI, 0.02 to 0.23 kg]); similar for fluoxetine (difference, −0.07 kg [CI, −0.19 to 0.04 kg]); and lower for bupropion (difference, −0.22 kg [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, while bupropion was associated with 15% reduced risk.
Authors noted a few limitations that may have affected their results, including limited data on medication dispensing, low patient medication adherence, and incomplete data on adherence and weight measures across time points.