Observed Metabolic, Hepatic and Renal Changes Alongside Symptomatic Improvement with Amitriptyline, Sertraline and...

Antidepressants of different classes are broadly comparable in antidepressant efficacy, while their physical effects may differ. Head-to-head observational data comparing a tricyclic antidepressant, a selective serotonin reuptake inhibitor and a serotonin-noradrenaline reuptake inhibitor across metabolic, hepatic, renal, electrolyte and thyroid measures in the same Indian clinical setting remain limited.

In this observational, record-based comparative study, 60 adults receiving antidepressant monotherapy for a depressive disorder were studied in three equal groups of 20 defined by the prescribed antidepressant - amitriptyline, sertraline or desvenlafaxine. Depression severity was measured with the 17-item Hamilton Rating Scale for Depression (HAM-D), and 20 physical parameters were recorded at baseline and endpoint. The retained records did not contain reliable information on treatment duration or antidepressant dose, and the exact calendar study period and prospective/retrospective mode of data acquisition were not documented. Within-group change was tested with paired t tests, between-group change with one-way analysis of variance, categorical characteristics with the chi-square test, and associations with Pearson correlation. A Bonferroni-corrected threshold of α = 0.0024 was applied to the 21 between-group comparisons.

Mean HAM-D scores decreased within each group by 3.75 points with amitriptyline, 2.10 with sertraline and 3.80 with desvenlafaxine; the between-group comparison of change was significant at the conventional 0.05 level but not after Bonferroni correction (F(2,57) = 3.21, p = 0.048, η² = 0.101). Response was recorded in 25.0%, 15.0% and 25.0% of participants, respectively. Anthropometric and laboratory measures showed changes in several domains, including increases in weight, waist circumference, glucose, lipids and hepatic enzymes and decreases in serum sodium and chloride. Seventeen of 21 between-group comparisons were significant at p < 0.05 and 11 remained significant after Bonferroni correction. The unusually uniform distribution of several laboratory variables limits confidence in the corresponding effect estimates until the source measurements are independently verified.

In this small, non-randomized observational cohort, HAM-D scores decreased in all three treatment groups and several anthropometric and laboratory measures changed over follow-up. The study cannot determine whether these changes were caused by the individual antidepressants or establish comparative safety profiles, particularly because treatment duration and dose were unavailable and several laboratory distributions were unusually uniform. The laboratory findings should therefore be considered hypothesis-generating pending verification against original source records. Monitoring recommendations should be based primarily on existing clinical guidance and the broader literature rather than on this study alone.