Lancet Study: Antidepressants Differ in Cardiometabolic Effects

A large Lancet network meta-analysis led by King’s College London and the University of Oxford pooled 151 randomized trials, 17 FDA reports and more than 58,000 patients to compare short-term physiological effects of 30 antidepressants. The study found clinically significant, drug-specific differences in weight (up to about 4 kg between agomelatine and maprotiline), heart rate (about a 21 beats-per-minute gap between fluvoxamine and nortriptyline) and blood pressure (roughly an 11 mmHg difference between nortriptyline and doxepin), and noted that some drugs also affected cholesterol. Older tricyclics and certain SNRIs (for example, maprotiline, amitriptyline, nortriptyline) were most often linked to weight gain and increases in heart rate and blood pressure, while many commonly prescribed SSRIs (such as sertraline) showed relatively mild cardiometabolic effects. The authors report that nearly half of patients on some medications experienced clinically important weight gain, which—along with cardiovascular changes—can reduce adherence and may have long-term health implications if not monitored. Researchers and clinicians said the findings support individualizing antidepressant choice to patients’ physical-health profiles, routine physical monitoring, and updates to prescribing guidelines, while emphasizing that antidepressants remain effective and should not be avoided when indicated.