Tuesday, July 2, 2024

Bupropion Linked to Lowest Weight Gain Among Common Antidepressants

Individuals taking bupropion gained the least weight on average compared with those taking one of seven other first-line antidepressants, though overall weight differences were small, according to a population-level study issued Monday in Annals of Internal Medicine.

“Weight gain is a commonly reported side effect of antidepressant use that may affect patients’ long-term metabolic health, given the difficulty of achieving and sustaining weight loss,” wrote Joshua Petimar, Sc.D., of Harvard Medical School and Harvard Pilgrim Health Care Institute and colleagues. “Antidepressant-associated weight gain may additionally lead to increased medication nonadherence, which is associated with poor clinical outcomes, including increased risk for depression relapse and hospitalization.”

Researchers studied the electronic health records of 183,118 adults 20 to 80 years old with first-time initiation of one of eight common antidepressants (sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, or venlafaxine) between July 2010 and December 2019. Patients’ weights were tracked at 6, 12, and 24 months, and results compared against the weight gained on sertraline, the most prescribed antidepressant of the group (20% of participants). The researchers excluded patients starting more than one antidepressant, those taking other common weight-changing medications (stimulants, steroids, or weight loss drugs), or those with recent history of cancer, pregnancy, or bariatric surgery.

The results at six months were as follows:

  • Patients taking sertraline gained an average of 1.5 kg (3.3 pounds).
  • Patients taking bupropion fared best, gaining 0.22 kg less weight than those taking sertraline.
  • Patients taking fluoxetine gained about the same amount as those taking sertraline.
  • Patients taking citalopram or venlafaxine gained between 0.1 and 0.2 kg more weight than those taking sertraline.
  • Patients taking duloxetine, escitalopram, or paroxetine fared the worst, gaining between 0.3 and 0.4 kg more weight than those taking sertraline.

Patients taking bupropion were also 15% less likely than those taking sertraline to gain at least 5% of their baseline weight after six months, whereas patients taking duloxetine, escitalopram, or paroxetine were 10-15% more likely to gain at least 5% of their baseline weight. Petimar and colleagues wrote that the favorable weight profile of bupropion may be related to its ability to activate the hypothalamic melanocortin system, which regulates feeding behaviors and energy balance.

Researchers noted that on average weight gain plateaued at around 12 to 18 months for the SNRIs duloxetine and venlafaxine, whereas weight gain continued among those taking SSRIs. However, due to rising medication nonadherence over time, long-term weight outcomes were less reliable.

Six months after initiation, only about 1 in 3 patients was still taking their initially prescribed antidepressant, with bupropion having the highest adherence (41%). At 24 months, only 4% to 5% of patients continued taking their initial antidepressant, and around 10% of them had added an additional medication.

For related information, see the American Journal of Psychiatry article, “Psychotropic Drug–Related Weight Gain and Its Treatment.”

(Image: Getty Images/iStock/viperagp)

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