Long-term antidepressant treatment in general practice: changes in body mass index

Chiwanda, Laura; Cordiner, Matthew; Thompson, Anne T.; Shajahan, Polash

doi:10.1192/pb.bp.115.052472

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…This contrasts with previous research indicating that long-term treatment with citalopram, fluoxetine, mirtazapine and sertraline was associated with increased BMI. 18 This could be attributed to the grouping of various antidepressants or recall bias, as participants might have misreported the duration of their antidepressant use. It should be noted that there are additional factors, such as the lifetime duration of antidepressant use, that were not captured in the NHANES data, which may have also influenced the observed outcomes.…”

Section: Discussionmentioning

confidence: 99%

Increased odds of high body mass index in depression with self-reported antidepressant use

Tassone,

Meshkat,

Pang

et al. 2023

Gen Psych

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Section: Discussionmentioning

confidence: 99%

Increased odds of high body mass index in depression with self-reported antidepressant use

Tassone,

Meshkat,

Pang

et al. 2023

Gen Psych

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“… 15 A UK study analysed data for 268 patients treated with antidepressants from a general practice with 11 994 registered patients, and concluded that weight gain persisted during long term treatment, with, in some instances, prescriptions maintained for several years. 16 Another US study evaluated weight gain in the 12 months after initiation of antidepressant treatment in 22 610 adults treated in clinics in New England and found differences in the propensity of individual antidepressants to result in weight gain. 17 …”

Section: Introductionmentioning

confidence: 99%

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

Gafoor

Booth

Gulliford

2018

BMJ

139

108

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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.

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“…Currently, there are no guidelines but there are several recent studies and reviews that contain clinically relevant information on the difference in response to certain AD in patients with obesity and with certain obesity classes (5,53,72,73). There are also published detailed recommendations on how to avoid the weight-increasing effect of AD (11,22,54,(74)(75)(76)(77)(78)(79)(80). Of note, it has been shown in a recent RCT that patients with morbid obesity may benefit from certain AD and AD combinations (5,53) and, therefore, require individualized approach to treatment.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Introduction: Depression is a serious disorder that brings a tremendous health and economic burden. Many antidepressants (AD) have obesogenic effects, increasing the population of obese patients at increased risk for a more severe disease course and poor treatment response. In addition, obese patients with depression may not be receiving the recommended standard of care due to "obesity bias." It is important to evaluate prescribing pharmacological treatment of depression in patients with obesity. Objectives: To describe the prevalence and patterns of AD prescribing for patients with depression and comorbid obesity compared with normal weight patients, and to examine the association of prescribing prevalence with obesity class. Methods: Study sample of adult patients (>18 years old) with depression was extracted from the national Canadian Primary Care Sentinel Surveillance Network (CPCSSN) Electronic Medical Records database for 2011-2016. Measures were prescribing of at least one AD (outcome) and body mass index (BMI) to categorize patients into weight categories (exposure). Data were analyzed cross-sectionally using descriptive statistics and mixed effects logistic regression model with clustering on CPCSSN networks and adjusting for age, sex, and the comorbidities. Results: Of 120,381 patients with depression, 63,830 patients had complete data on studied variables (complete cases analysis). Compared with normal weight patients, obese patients were more likely to receive an AD prescription (adjusted Odds Ratio [aOR] = 1.17; 95% Confidence Interval [CI]: 1.12-1.22). Patients with obesity classes II and III were 8% (95% CI: 1.00, 1.16) and 6% (95% CI: 0.98, 1.16) more likely, respectively, to receive AD. After imputing missing data using Multiple Imputations by Chained Equations, the results remained unchanged. The prevalence of prescribing >3 AD types was higher Puzhko et al. Antidepressants Prescribing in Patients With Obesity in obese category (7.27%, [95% CI: 6.84, 7.73]) than in normal weight category (5.6%; [95% CI: 5.24, 5.99]). Conclusion: The association between obesity and high prevalence of AD prescribing and prescribing high number of different AD to obese patients, consistent across geographical regions, raises a public health concern. Study results warrant qualitative studies to explore reasons behind the difference in prescribing, and quantitative longitudinal studies evaluating the association of AD prescribing patterns for obese patients with health outcomes.

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Long-term antidepressant treatment in general practice: changes in body mass index

Cited by 4 publications

References 9 publications

Increased odds of high body mass index in depression with self-reported antidepressant use

Increased odds of high body mass index in depression with self-reported antidepressant use

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

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

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