Antidepressant utilisation and incidence of weight gain during 10 years’ follow-up: population based cohort study

Abstract

ObjectiveTo evaluate the long term association between antidepressant prescribing and body weight.DesignPopulation based cohort study.SettingGeneral practices contributing to the UK Clinical Practice Research Datalink, 2004-14.Participants136 762 men and 157 957 women with three or more records for body mass index (BMI).Main outcome measuresThe main outcomes were antidepressant prescribing, incidence of ≥5% increase in body weight, and transition to overweight or obesity. Adjusted rate ratios were estimated from a Poisson model adjusting for age, sex, depression recording, comorbidity, coprescribing of antiepileptics or antipsychotics, deprivation, smoking, and advice on diet.ResultsIn the year of study entry, 17 803 (13.0%) men and 35 307 (22.4%) women with a mean age of 51.5 years (SD 16.6 years) were prescribed antidepressants. During 1 836 452 person years of follow-up, the incidence of new episodes of ≥5 weight gain in participants not prescribed antidepressants was 8.1 per 100 person years and in participants prescribed antidepressants was 11.2 per 100 person years (adjusted rate ratio 1.21, 95% confidence interval 1.19 to 1.22, P<0.001). The risk of weight gain remained increased during at least six years of follow-up. In the second year of treatment the number of participants treated with antidepressants for one year for one additional episode of ≥5% weight gain was 27 (95% confidence interval 25 to 29). In people who were initially of normal weight, the adjusted rate ratio for transition to overweight or obesity was 1.29 (1.25 to 1.34); in people who were initially overweight, the adjusted rate ratio for transition to obesity was 1.29 (1.25 to 1.33). Associations may not be causal, and residual confounding might contribute to overestimation of associations.ConclusionWidespread utilisation of antidepressants may be contributing to long term increased risk of weight gain at population level. The potential for weight gain should be considered when antidepressant treatment is indicated.

Health in Preconception, Pregnancy and Postpartum Global Alliance: International Network Pregnancy Priorities for the Prevention of Maternal Obesity and Related Pregnancy and Long-Term Complications

“…This research priority includes specific attention to gestational diabetes mellitus, hypertension, fetal growth monitoring and other complications, all with direct implications on pregnancy and offspring outcomes and that interact with maternal lifestyle, BMI and gestational weight gain [7]. Risk profiling and medications (including use of antipsychotic and antidepressant medications that are linked with weight gain [33]) are also included here. This priority focuses on ensuring pregnancy-specific factors relating to health are adequately addressed.…”

Evaluating Prevalence and Patterns of Prescribing Medications for Depression for Patients With Obesity Using Large Primary Care Data (Canadian Primary Care Sentinel Surveillance Network)

“…We cannot state with certainty whether AD were initially prescribed to obese patients or if prescribing AD contributed to a greater proportion of obese patients with AD prescriptions. The latter possibility, however, is of equal concern, since utilization of AD may contribute to increasing the risk of a long-term weight gain at the population level, moving normal weight and overweight patients to the obesity group (22). It has been reported that at least 1.5% of the obesity rate increase among young adults in the USA during the last two decades can be explained by the increase in the prevalence of depression and AD use (54).…”

“…It is imperative, therefore, to evaluate the prevalence and patterns of prescribing pharmacological treatment to patients with depression and comorbid obesity and to examine the association between obesity and AD prescribing. To our knowledge, very few studies (21,22) evaluated how health providers prescribe AD to obese and overweight patients with depression; they showed that utilization of AD may be contributing to population-level increases in excess weight [(22), UK] and that obese patients are less likely to receive recommended standards of care [(21), USA]. To our knowledge, no study evaluated the prevalence and patterns of AD prescribing to patients with obesity in Canada or the association of certain prescribing patterns with the class of obesity.…”

Incidence of suicidal behaviour and violent crime following antidepressant medication: a Danish cohort study

“…Pharmacotherapy is an effective treatment of major depression and antidepressants are among the most commonly prescribed drugs in most Western countries . Consequently, the potential side‐effects of antidepressants have been the subject of considerable attention . Especially after the introduction of selective serotonin reuptake inhibitors (SSRI) on the market, reports of suicidality and aggressive behaviour emerged and eventually led to warnings issued by regulatory agencies in several countries .…”