Medication-Induced Weight Change Across Common Antidepressant Treatments : A Target Trial Emulation Study.

Area of Science:

• Pharmacology and clinical therapeutics
• Comparative effectiveness research
• Mental health treatment outcomes

Background:

• Antidepressants are widely prescribed, yet comparative data on weight change for first-line treatments are limited.
• Understanding differential weight effects is crucial for patient adherence and treatment success.

Purpose of the Study:

• To compare weight change associated with initiating common first-line antidepressant treatments.
• To emulate a target trial using real-world electronic health record data.

Main Methods:

• An observational cohort study analyzed 183,118 patients over 24 months using electronic health record (EHR) data.
• Population-level effects of initiating sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, or venlafaxine were estimated using inverse probability weighting.

Main Results:

• Bupropion was associated with the least weight gain (0.22 kg less than sertraline) and a reduced risk of significant weight gain.
• Escitalopram, paroxetine, and duloxetine showed higher mean weight gain (0.34-0.41 kg more than sertraline) and increased risk of substantial weight gain.
• Medication adherence varied, with duloxetine at 28% and bupropion at 41% over six months.

Conclusions:

• Small but significant differences in mean weight change exist among first-line antidepressants.
• Bupropion demonstrated the most favorable weight profile, while certain others were linked to greater weight gain.
• These findings suggest clinicians should consider potential weight effects when selecting antidepressant therapy.