Antidepressant Side Effects Ranked for the First Time

For the first time, the side effects of various antidepressants have been ranked, showing significant differences across different medications.

Researchers examined the effects of these drugs on patients during the first eight weeks of treatment. Their findings indicated that some medications led to weight gain of up to 2kg or caused heart rates to fluctuate by as much as 21 beats per minute.

Approximately eight million people in the UK are on antidepressants.

The researchers cautioned that these varying side effects might influence overall health and adherence to prescribed treatments.

While no one should suddenly discontinue their medication, they emphasized the need for antidepressants to be carefully tailored to individual needs.

“There are significant differences among antidepressants, which is crucial not just for individuals but also for the broader population, as even small changes could have substantial impacts,” stated researcher Prof. Oliver Howes.

Historically, it’s been understood that antidepressants affect physical health. The recent study from King’s College London and the University of Oxford is the first to create a comparative ranking of these effects.

The research team analyzed 151 studies involving 30 different antidepressants and over 58,500 patients.

Although not everyone experiences side effects, the results published in the Lancet revealed:

• Agomelatine typically resulted in a 2.4kg weight loss compared to maprotiline, which was associated with nearly 2kg weight gain.
• Fluvoxamine reduced heart rates while nortriptyline increased them, demonstrating a difference of 21 beats per minute.
• Blood pressure varied by 11 mmHg between nortriptyline and doxepin.

“Clearly, no two antidepressants are alike,” remarked Dr. Atheeshaan Arumuham from King’s College London.

Such variations can accumulate, potentially leading to heightened risks for issues like heart attacks or strokes.

This implies that even individuals with the same diagnosis could benefit from different antidepressants based on personal preferences and other health concerns.

Choosing the Right Antidepressant

Imagine three individuals: Sarah, 32, John, 44, and Jane, 56. Each has been diagnosed with depression, yet their preferences regarding side effects differ.

Sarah wishes to avoid weight gain, while John is already dealing with high blood pressure and Jane has elevated cholesterol.

According to Dr. Toby Pillinger, each person would require a different medication tailored to their specific needs.

Dr. Toby Pillinger says: For Sarah, it’s best to choose an antidepressant that doesn’t cause weight gain, like agomelatine, sertraline, or venlafaxine, rather than options like amitriptyline or mirtazapine that tend to increase weight.

Dr. Toby Pillinger says: John should steer clear of drugs that might raise his blood pressure, such as venlafaxine or amitriptyline, and he would do better with citalopram, escitalopram, or paroxetine.

Dr. Toby Pillinger says: Jane should avoid medications linked to high cholesterol, including venlafaxine and duloxetine. Citalopram or escitalopram would likely be better options for her.

Discussion on Antidepressant Accessibility

The researchers agreed it’s overly simplistic to categorize antidepressants strictly as good or bad. For instance, while amitriptyline may lead to weight gain and increased heart rate, it’s also effective for pain management and sleep issues.

SSRIs, the most frequently prescribed antidepressants, such as paroxetine and citalopram, generally show fewer physical side effects.

Interestingly, fluoxetine, commonly known as Prozac, was associated with weight loss in some cases, but also with increased blood pressure.

Prof. Andrea Cipriani from Oxford highlighted the difficulty in assessing how many individuals on antidepressants might benefit from a switch. He noted a trend toward “generic, inexpensive medications,” with a staggering 85% of prescriptions in the UK being for just three SSRIs.

Implementing the study’s findings could drastically change this statistic, offering a chance for better treatment options for more people.

The research team is in the process of creating a free online tool aimed at helping doctors and patients make informed medication choices.

However, significant cultural shifts within the NHS would be necessary for these findings to take effect.

It’s also worth mentioning that the study only monitored outcomes for eight weeks, and while there is hope that these short-term changes will remain, further validation is still needed.

Dr. Prasad Nishtala from the University of Bath, who wasn’t involved in this research, described the findings as both novel and important.

He mentioned that in real-world scenarios, where patients often remain on antidepressants for extended periods, the cumulative risks could be heightened, especially in those with chronic depression.