Weight outcomes among antidepressant users in nursing facilities

Area of Science:

• Geriatric Medicine
• Psychopharmacology
• Clinical Nutrition

Background:

• Depression is common in nursing facility residents, often co-occurring with weight concerns.
• Traditional beliefs suggest TCAs increase appetite and SSRIs decrease it in older adults.
• Evidence is limited on long-term weight effects of antidepressants in this population.

Purpose of the Study:

• Compare 6-month weight outcomes in nursing facility residents using TCAs, SSRIs, or other antidepressants versus no antidepressant.
• Investigate if antidepressant choice correlates with pre-treatment weight patterns, indicating prescribing bias.

Main Methods:

• Retrospective cohort study using Minimum Data Set--Plus (MDS+) data from Kansas nursing facilities.
• Included 1,157 antidepressant users (age 65+) and 4,852 non-users, all on single-agent therapy for ≥6 months.
• Analyzed clinically important weight loss/gain (≥10% change) and mean weight changes, controlling for confounders.

Main Results:

• No significant association found between TCA use and weight gain.
• SSRI use showed a modest association with weight gain and a trend toward weight loss after controlling for confounders.
• Statistically significant mean weight differences between groups were minimal (<3 pounds) and likely due to large sample size.

Conclusions:

• Widely held beliefs that TCAs facilitate weight gain and SSRIs cause significant weight loss in older adults are not supported by this study.
• Observed weight changes are not clinically significant, suggesting clinicians should re-evaluate these prescribing assumptions.
• Antidepressant selection was not biased by prior weight patterns in this cohort.