SSRI antidepressant use potentiates weight gain in the context of unhealthy lifestyles: results from a 4-year Australian follow-up study

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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“…The relation between depression symptoms and health behaviours that might contribute to weight gain is also a relevant concern. 30 …”

Section: Discussionmentioning

confidence: 99%

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

Gafoor

Booth

Gulliford

2018

BMJ

134

108

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“…Among the antidepressants studied, Mirtazapine, Fluoxetine, Citalopram, Escitalopram, Sertraline, Paroxetine, Trazodone, Venlafaxine, and Duloxetine had a positive association with weight gain. However, some studies evaluating TCAs did not show association, but several studies with Bupropion showed weight loss …”

Section: Resultsmentioning

confidence: 99%

“…In two studies, the number of women was more than double the number of men, because a greater proportion of women are affected by depression. Regarding the duration of the studies, we identified studies of less than 5 years, and others with more than 10 years of follow‐up …”

Section: Resultsmentioning

confidence: 99%

Effects of antidepressant and antipsychotic use on weight gain: A systematic review

2019

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Weight gain is an adverse effect of antidepressants and antipsychotics. This side effect can lead to numerous comorbidities and reduces life expectancy. The use of these drugs is increasing worldwide, and the weight gain produced by them represents a common clinical challenge. The goal of this systematic review was to evaluate the potential association of antidepressant and antipsychotic therapy with body weight gain in cohort studies. A search of cohort studies investigating the association between weight gain and the use of antidepressants and antipsychotics in individuals was conducted through the PubMed database from 1 January 2008 to 31 January 2019 following the PRISMA statement. We found 27 independent eligible cohort studies that included children (2-18 years old) and adult (18-103 years old) subjects.Most of the included studies showed a 5% weight gain in individuals using antidepressant therapy. However, Quetiapine, Haloperidol, Trifluoperazine, Risperidone, Aripiprazole, Olanzapine, and Clozapine increased body weight ≥7% from baseline, which is considered a clinically significant result. Weight loss was found in individuals treated with Bupropion. Further cohort studies with higher sample sizes and longer durations of treatment are needed to confirm our observations. KEYWORDS antidepressant, antipsychotic, drug, weight gain, mental disorders 1 | BACKGROUND During the last decade, the prevalence of mental disorders has increased, comprising of 22.8% the global disease burden 1 and causing significant effects on people's health with negative socio-economic consequences. 2 There are 350 million people affected by mental disorders around the world 3 . The disorders include depression, bipolar disorders, schizophrenia and other psychosis, dementia, and developmental disorders (autism spectrum disorder [ASD]). The World Health Organization (WHO) indicates that mental disorders affect people from any age, social condition, or country. 4 Depression is the most common mental disorder. This disease may produce mental distress and also influences simple daily tasks affecting family and work relationships. 2 Moreover, depression is considered as the main cause of disability, contributing to a high morbidity and mortality. 2 In the worst-case scenario, depression can lead to suicide, which nowadays is considered the second leading cause of death among people 15 to 29 years old. 4 When talking about this disease, the WHO gives special attention to the three most affected population groups nowadays, which are young people from 15 to 24, women in childbearing age (especially after child birth), and people over 60 years old. The WHO estimates that the number of people affected

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“…Significant improvements were seen in some health behaviours (emotional eating, cognitive restraint, and total physical activity; Table 3), and trends toward improvements seen in others (uncontrolled eating [p = .127] and discretionary food intake [p = .084]). Physical activity, nutrition, and eating behaviours are confounding variable that may prevent weight loss (particularly when accompanied by an unhealthy lifestyle) is antidepressant therapy [23,24], and 11 of our 18 subjects were taking antidepressants during the program. While our current trial was not designed nor powered to answer the question of whether antidepressant status affects weight loss during/after the intervention, larger future trials can incorporate this question into their design.…”

Section: Discussionmentioning

confidence: 99%

“…Behaviourally, a person who experiences depression may reduce their activity and increase their intake of comfort foods, resulting in weight gain and elevated cortisol, which in turn promotes appetite (especially for less healthy foods) and further weight gain [19,21,22]. Antidepressants may also be associated with increased appetite and weight gain, particularly in the context of unhealthy lifestyles [23,24]. Cognitively, negative thinking patterns and low self-worth contribute to distress and unhelpful behavioural responses.…”

Section: Introductionmentioning

confidence: 99%

Pilot trial of a group cognitive behavioural therapy program for comorbid depression and obesity

et al. 2020

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Background: Depression and obesity are significant global health concerns that commonly occur together. An integrated group cognitive behavioural therapy program was therefore developed to simultaneously address comorbid depression and obesity. Methods: Twenty-four participants (63% women, mean age 46 years) who screened positively for depression with a body mass index ≥25 were recruited from a self-referred general population sample. The group therapy program (10 two-hour weekly sessions) was examined in a single-arm, before-after pilot trial, conducted in a behavioural health clinic in Adelaide, Australia. Primary outcomes included survey and assessment-based analyses of depression, anxiety, body image, self-esteem, and weight (kg), assessed at four time-points: baseline, post-intervention, threemonths and 12-months post program. Eighteen participants (75%) completed the program and all assessments. Results: Significant improvements in depression, anxiety, self-esteem and body shape concern scores, several quality of life domains, eating behaviours and total physical activity (among others)but not weightwere observed over the course of the trial. Conclusions: Results from this pilot trial suggest that combining interventions for depression and obesity may be useful. Further development of the program, particularly regarding the potential for physical health benefits, and a randomised controlled trial, are warranted.

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SSRI antidepressant use potentiates weight gain in the context of unhealthy lifestyles: results from a 4-year Australian follow-up study

Cited by 24 publications

References 19 publications

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

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

Effects of antidepressant and antipsychotic use on weight gain: A systematic review

Pilot trial of a group cognitive behavioural therapy program for comorbid depression and obesity

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