Millions of people around the globe rely on antidepressants to manage mental health conditions such as depression and anxiety. While these medications are often effective, they can also lead to various physical side effects, including weight gain, heart rate fluctuations, and changes in blood pressure. A new study, however, indicates that not all antidepressants have the same impact on the body, underscoring the importance of personalized prescriptions.
The research, conducted by a team of experts, analyzed 151 randomized trials involving 58,534 participants and 30 different antidepressants. Each trial recorded routine clinical measures such as blood pressure, body weight, and heart rate over approximately eight weeks. The findings reveal significant differences in the physical effects of these drugs, which could have substantial implications for the millions who take them.
Unveiling the Differences: A Network Meta-Analysis
The study employed a method known as network meta-analysis, allowing researchers to compare multiple treatments simultaneously. This approach effectively creates a “league table” of treatments, ranking them from best to worst for each physical health outcome. The results were striking, showing that even after just eight weeks, the physical effects of various antidepressants were far from subtle.
For instance, weight changes varied significantly between drugs. Participants taking agomelatine lost an average of 2.5 kg, while those on maprotiline gained nearly 2 kg. Heart rate effects also showed considerable variation, with fluvoxamine lowering heart rate by about eight beats per minute, whereas nortriptyline increased it by around 14 beats per minute.
“The spread in systolic blood pressure was more than 11 mmHg between doxepin and nortriptyline,” the study noted.
In terms of cholesterol and blood sugar levels, several antidepressants, including paroxetine, venlafaxine, desvenlafaxine, and duloxetine, were linked to higher total cholesterol. Duloxetine was also associated with increased blood sugar levels.
Implications for Long-Term Use and Monitoring
It’s crucial to highlight that this analysis focused on antidepressant treatment lasting around eight weeks. Given that many individuals use these medications for extended periods, the real-world, long-term physical effects could be more pronounced. This underscores the necessity of routine monitoring for patients on antidepressants.
The study also concentrated on objective outcomes consistently recorded in trials. Some significant physical issues, such as sexual side effects, were not included due to a lack of data. Future research should aim to explore these outcomes further.
“The results should not be interpreted as a list of ‘good’ and ‘bad’ antidepressants,” the researchers emphasized.
Instead, the findings illustrate the varied physical effects of different drugs, highlighting the importance of tailoring prescriptions to individual patients.
Personalized Prescribing: A New Approach
Historically, debates around antidepressants have centered on their efficacy and side effects. This study suggests a more pertinent question: which drug is best suited for which patient, considering their physical health and personal priorities?
The data clearly show that antidepressants are not interchangeable. For someone with obesity, diabetes, or hypertension, selecting a medication with a neutral impact on weight, blood sugar, and blood pressure is logical. Conversely, for an underweight individual with low blood pressure, the trade-offs may differ.
In light of these findings, it is more critical than ever for doctors to collaborate closely with patients to understand their priorities and match them with the appropriate antidepressant. This presents a challenge, as physicians must consider numerous antidepressants and their potential side effects.
Tools for Better Decision-Making
To aid this process, the researchers have developed a freely available tool that doctors and patients can use together to choose the right antidepressant. This tool allows users to select the side effects they wish to avoid and prioritize them. It then integrates these preferences with side-effect databases to produce a personalized table of options, ranking antidepressants based on the patient’s needs.
While antidepressants remain effective for many, this study highlights that they are not all the same. The evidence now shows that their effects on weight, blood pressure, heart rate, and blood sugar differ in clinically meaningful ways.
“Rather than argue for or against antidepressants as a group, we should focus on matching the medicine to the person,” the study concludes.
With tools like the one developed by the researchers, patients can receive prescriptions that are safer and better tolerated, fostering shared decision-making between doctors and patients.
Courtesy of The Conversation. This material from the originating organization/author(s) might be of the point-in-time nature, and edited for clarity, style, and length. Mirage.News does not take institutional positions or sides, and all views, positions, and conclusions expressed herein are solely those of the author(s).
