A team of British neuroscientists conducted a comprehensive study that included data from more than 58,500 participants, comparing 30 different types of antidepressants.
The results showed that these drugs differ significantly in their physiological effects, particularly with regard to cardiovascular health.
Amitriptyline, a commonly used tricyclic antidepressant, has been shown to cause weight gain in about half of patients, along with elevated heart rate and blood pressure, increasing the risk of heart disease and even death.
Patients taking amitriptyline gained 1.5 kg over eight weeks, increased their heart rate by 9 beats per minute, and increased their systolic blood pressure by 5 mm Hg, increasing their risk of stroke by 5% and their risk of death from any cause by 10%.
Nortriptyline was also observed to increase heart rate by more than 13 beats per minute, while other medications such as mirtazapine and tricyclic antidepressants similarly affected weight. Overall, researchers observed a difference of up to 4 kg in weight change depending on the type of medication.
"Not all antidepressants are created equal," explained Dr. Toby Bellinger, a consultant psychiatrist. "Some medications cause significant changes in weight, blood pressure, and heart rate over a short period, while SSRIs tend to have fewer physical effects."
The study showed that patients taking citalopram lost approximately 0.65 kg, with a decrease in heart rate and systolic blood pressure, and a slight increase in diastolic blood pressure.
The study emphasized the need to select antidepressants based on each patient's condition, and to monitor weight, blood pressure, and heart rate during treatment.
"In real life, where patients receive antidepressants for months or years, the cumulative risks may be higher, especially in those with chronic depression or existing metabolic conditions," said Dr. Prada Nishatala.
Professor Andrea Cipriani, from the University of Oxford, highlighted the importance of shared decision-making between doctor and patient: "The patient's preferences, personal circumstances, goals, and values should be incorporated into treatment decisions, and this approach should be adopted globally."
