Media release

From: American College of Physicians

1. Medication choice may affect weight gain when initiating antidepressant treatment
Bupropion associated with least weight gain among 8 first-line antidepressants
Abstract: https://www.acpjournals.org/doi/10.7326/M23-2742
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A target trial emulation study found small differences in short- and longer-term mean weight change among patients initiating treatment with one of 8 first-line antidepressants. Among the medications included in the trial, bupropion was consistently associated with the least weight gain. These findings are important because patient concerns about weight gain may affect medication adherence. The study is published in Annals of Internal Medicine.

Researchers from Harvard Medical School and Harvard Pilgrim Health Care Institute studied electronic health records for more than 183,000 adults initiating treatment with one of 8 first-line antidepressants to assess changes in weight by medication at 6, 12, and 24 months after participants started taking it. Medications studied included the commonly prescribed sertraline, citalopram, bupropion, escitalopram, fluoxetine, venlafaxine, paroxetine, and duloxetine. The researchers found differences in medication-induced weight gain both within and between antidepressant subclasses. At 6 months, users of escitalopram, paroxetine, and duloxetine gained approximately 0.3 to 0.4 kg more weight and were 10% to 15% more likely to gain at least 5% of their baseline weight than sertraline users. Bupropion users gained 0.22 kg less weight and were 15% less likely to gain at least 5% of their baseline weight than sertraline users. Fluoxetine use was not associated with 6-month weight change compared with sertraline use. According to the study authors, clinicians and patients may wish to consider these differences when making decisions about which specific antidepressant to start, especially for patients who are concerned about weight gain.