A recently published systematic review has reported that different antidepressants have significantly different physiological effects, a finding that is relevant to many, including the 17% of the adult population of North America and Europe currently being prescribed antidepressants.
Published in the prestigious medical journal The Lancet, the review of 26,252 citations – 151 of which met the inclusion criteria – reported significant differences in areas such as weight gain, blood pressure, and heart rate. The differing effects on weight gain/loss were such that the authors report a 4 kg difference in weight change between two types of antidepressant (agomelatine and maprotiline). The effects on heart rate were such that the authors reported a change of over 21 beats per minute in heart rate between fluvoxamine and nortriptyline.
The 151 studies contained within them 58,534 participants, and featured 30 different antidepressants. Importantly, one of the inclusion criteria was that studies used a placebo group, giving greater weight to the claims made in the review.
Some physiological markers, such as concentrations of sodium, potassium, urea, and creatinine, seemed invariable between antidepressant types.
Differences
When individuals were taking certain antidepressants, they were likely to lose or gain weight, when compared with individuals taking placebos. Antidepressants such as agomelatine and fluoxetine were associated with weight loss, while maprotiline and amitriptyline, among others, were associated with weight gain. The review reports that maprotiline and amitriptyline caused weight gain in 48.1% and 46.3% of those who were taking them, respectively, while agomelatine caused weight loss in 55% of people taking it.
Increases in heart rate were reported in 10 antidepressants, including nortriptyline and clomipramine, while decreases in heart rate were reported in fluvoxamine and moclobemide. Both increases and decreases in systolic blood pressure were reported, as well as increases and decreases in diastolic blood pressure. In terms of cholesterol, results indicate that antidepressants such as desvenlafaxine and venlafaxine, among others, led to an increase. Increases in glucose were also reported with duloxetine.
Conclusion
The review underscores the importance of personalization when prescribing antidepressants, made even more critical by the reality that depression often co-occurs with comorbidities. These physiological differences and effects are more tangible and measurable than other differences that also might occur, such as changes to thoughts and emotions, which will be much more difficult to ascertain. In this is a reminder of the importance of each individual and their carers’ and loved ones’ roles in determining how antidepressants may be affecting them. It also recalls the potential value in supplementing antidepressants with psychological support, not only to create a space within which the impact of antidepressants might be fleshed out, but also tending to behavioral responses that could address side effects such as weight gain.
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