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The study included the most commonly prescribed medications for depressive and anxiety disorders, bipolar disorder therapy, fibromyalgia, obsessive-compulsive disorder, and other conditions.
The article notes that differences in body weight changes among patients taking medications based on different active substances reached 4 kg over a short treatment course (approximately 8 weeks). For example, agomelatine promoted weight loss averaging 2.44 kg compared to placebo, while maprotiline caused weight gain up to 1.82 kg.
For changes in heart rate, the gap between medications exceeded 21 beats per minute. For instance, fluvoxamine reduced pulse by 8.18 beats per minute, while nortriptyline, conversely, increased it by 13.77.
Additionally, some antidepressants raised cholesterol and glucose levels despite causing weight loss. Duloxetine, desvenlafaxine, and venlafaxine were associated with increases in total cholesterol of 0.17–0.27 mmol/L and glucose up to 0.3 mmol/L. These metabolic shifts may covertly increase cardiovascular disease risk.
Side effects were particularly pronounced with medications having antihistaminic and serotonergic mechanisms of action, such as amitriptyline and mirtazapine. According to the study, these drugs most frequently caused weight gain and blood pressure changes, especially in elderly patients and individuals with overweight and obesity.
The study authors emphasize that clinical guidelines for prescribing antidepressants need updating to account for differences in physiological risks. However, medication selection should be individualized, physicians must consider the clinical picture, physical condition, and preferences of the patient, their family, and treating specialists.
All modern antidepressants are registered and used in Russia, including those designed to minimize side effects. Such medications are prescribed by physicians based on diagnostic evaluation and as part of a comprehensive psychotherapy regimen.
Source: The Lancet
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