Prescribers should remember to consider physical side effects of antidepressants: study

Findings from a new systematic review suggests that antidepressants have clear and meaningful differences in their physiological effects. The researchers said that physicians should take these into account when considering which treatment may work best for their patient. “Our findings show that SSRIs, which are the most prescribed type of antidepressant, tend to have fewer physical side-effects, which is reassuring. But for others, closer physical health monitoring may be warranted,” lead author Dr. Toby Pillinger, an academic clinical lecturer in the Institute of Psychiatry, Psychology and Neuroscience at King’s College in London, said in a university press release.“The aim isn’t to deter use, but to empower patients and clinicians to make informed choices and to encourage personalized care,” he said.The researchers reviewed 151 studies which, in total, included more than 58,000 patients. All studies included a comparison of an antidepressant to a placebo. Using a method called network meta-analysis, the researchers created a table on how different medications affect physical factors such as weight, heart rate and blood pressure.Treatments varied in their impact on weight. The range included an average weight loss (compared to placebo) of 2.44 kg in people taking agomelatine to an average weight gain (compared to placebo) of 1.82 kg in those taking maprotiline. The researchers found strong evidence of weight loss with fluoxetine (0.8 kg) and bupropion (0.8 kg), among others.There was also variation in antidepressants’ effect on heart rate. Fluvoxamine lowered heart rate by eight beats a minute, where nortriptyline increased heart rate by an average of 14 beats per minute. There was strong evidence of an increase in average heart rate compared to placebo with clomipramine (9.74 beats per minute), and amitriptyline (9.25 beats per minute), among others.The researchers found average systolic blood pressure increased compared to placebo with amitriptyline (4.86 mmHg), venlafaxine (2.78 mmHg) and others. There was a rise in diastolic blood pressure with amitriptyline (2.48 mmHg), venlafaxine (2.55 mmHg) and others. Some medications were associated with higher total cholesterol, including paroxetine, venlafaxine, desvenlafaxine and duloxetine.“The majority of the studies we looked at were relatively short. We’re looking at eight weeks’ duration and still within that duration we were seeing large changes in physical health parameters which we would argue have clinical relevance,” Dr. Pillinger said in an interview with the BBC.The findings support the importance of monitoring patients on antidepressant medications.“In a real-world setting, where patients often receive antidepressants for months or years, the cumulative risks are likely to be higher, particularly among those with chronic depression,” Prasad Nishtala from the Centre for Therapeutic Innovation at the University of Bath in the U.K., when asked to comment by the BBC. Sexual, gastrointestinal and emotional blunting side effects were not included in the study due to lack of data, the researchers wrote.The research group previously developed a digital tool to help patients and physicians choose the most appropriate treatment. The findings from this paper could lead to further digital tools to help with shared decision-making, the researchers noted. The Canadian Network for Mood and Anxiety Treatment (CANMAT) guidelines for treatment of major depressive disorder note that clinicians should discuss adverse effects of medications with patients. The study was published in The Lancet.

Prescribers should remember to consider physical side effects of antidepressants: study

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