A major British study published in The Lancet has found that antidepressants can induce cardiometabolic and other physiological changes and these effects vary widely between antidepressants. Some can cause clinically significant changes in body weight, heart rate, and blood pressure within just a few weeks. These changes may, over time, raise the risk of cardiovascular disease, such as heart attack or stroke.
Researchers combined data from 151 clinical trials and 17 Food and Drug Administration reports, covering 58,534 participants.
They compared the effects of 30 different antidepressants with a placebo over a treatment period of eight weeks.
Selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed class of antidepressants, were found to cause little or no adverse physical side effects. However, other antidepressants showed much greater variation in their impact on the body.
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For instance, there was about a 4kg difference in average weight change between certain drugs. Agomelatine was associated with an average 2.5kg weight loss, while maprotiline led to an average 2kg weight gain. Nearly half of the people taking maprotiline or amitriptyline gained weight, while over half of those on agomelatine lost weight.
Antidepressants also differed in their effects on the heart and circulation. Increases in heart rate were reported with 10 antidepressants, including nortriptyline and clomipramine, while decreases in heart rate were reported with fluvoxamine and moclobemide.
Both increases and decreases in systolic blood pressure and diastolic blood pressure were observed, as well as increases in total cholesterol and glucose concentrations.
Most antidepressants did not significantly affect kidney or liver function, electrolyte balance, or heart rhythm.
The researchers emphasised that these findings should not dissuade patients from taking antidepressants, which are safe and effective treatments for depression and other mental health conditions. Instead, the results highlight the importance of personalised treatment. Health care providers should prescribe medications that best fit each patient’s health profile and goals.
