Different people may benefit from some antidepressants over others, depending on their side effects.
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Antidepressants They vary greatly in the side effects they cause, from weight gain to weight loss to changes in blood pressure. This may be something to consider when doctors decide which of the many life-saving drug options is best for each person.
About 1 in 10 people in Europe And USA Take antidepressants for conditions such as depression and anxiety. Withdrawal symptoms may be less frequent than we thought, but some studies hint that there may be physical side effects while you are taking these drugs. It's just not clear which drug causes which side effect.
Diving deeper into the data Toby Pillinger from King's College London and colleagues analyzed the results of 151 randomized controlled trials and 17 reports from the US Food and Drug Administration. The study included 30 antidepressants, the effectiveness and side effects of which were compared with placebo over an eight-week course of treatment for various mental illnesses.
“The beauty of these studies is that they were all placebo-controlled and randomized, so we can be confident that the differences we see are due to the drug,” says Pillinger.
Researchers found that some of drugs were associated with weight loss, while others were associated with weight gain. Maprotiline, for example, was associated with an average weight gain of approximately 1.8 kg, while agomelatine was associated with a loss of approximately 2.4 kg.
The study also found that the drug fluvoxamine was associated with a slower heart rate by an average of 8 beats per minute (bpm), while nortriptyline increased it by 13 bpm. The latter also reduces systolic blood pressure (blood pressure during the heartbeat) by 3 to 7 millimeters of mercury (mmHg), while doxepin increases it by almost 5 mmHg. Art., which may have side effects on overall health. health. “Every increase in blood pressure by 1 mm Hg. Art., if you have high blood pressure, increases the risk of stroke by 1 percent,” says a team member. Oliver Howesalso at King's College London.
Other drugs such as paroxetine, duloxetine, desvenlafaxine and venlafaxine have been associated with increased cholesterol levels. It is unclear whether these side effects get worse, better, or stop after eight weeks.
Despite observational studies that have raised concerns that antidepressants affect the levels of electrolytes such as sodium in the blood, which can affect heart rate, “our study showed that there really wasn't any problem with sodium,” Pillinger says.
Belonging More than 92 million doses of antidepressants have been prescribed in England last year about 85 percent were either sertraline, mirtazapine, fluoxetine, amitriptyline, citalopram or venlafaxine. Four of them were found to have a relatively good profile for most of the factors examined, but amitriptyline was seen to increase weight, heart rate and blood pressure, while venlafaxine increased heart rate, blood pressure and cholesterol levels.
“It’s very informative for both doctors and patients,” says Mahyar Etminan at Epilytics Epidemiology Consulting Group in Vancouver, Canada. “This data can be put into an app, so that, for example, if someone has high cholesterol or cardiovascular problems, the app can tell the doctor which one to avoid. This will give doctors more options to choose the antidepressant that is best for the patient.”
Pillinger says his team is developing a digital tool with a drop-down menu of common antidepressant side effects so clinicians can assess what to avoid or even which to choose, e.g. weight loss it would be useful. “It’s all about finding the right molecule for the right person and customizing it,” says Pillinger.
But John Ioannidis at Stanford University in California say the results may be biased if the team only included studies that showed side effects. Others may have found side effects that they did not report, meaning these data were not included in the meta-analysis.
He also notes that people typically take antidepressants for longer than 8 weeks; sometimes for years. “Very different long-term studies are needed to show the presence and relevance of such effects, if any, in the long term,” says Ioannidis.
In response, Pillinger says that “there is always a risk of bias,” but “we can be relatively confident that we have collected most of the available data.”
He acknowledges that analysis of the long-term studies he says his team is working on is needed, and notes that about 75 percent of participants in existing studies have been white. But he believes the patterns the team found will emerge in long-term studies and will likely apply to other groups.
Previous studies have shown that some antidepressants, such as venlafaxine, associated with increased long-term blood pressurehe says. Weight gain that happens quickly can also last a long time, he says. “Once you gain weight, it will be difficult to get rid of.”
However, people taking antidepressants who are concerned about side effects should not stop treatment, says Howes, as these medications can be very effective. “It's nuanced; it's an individualized decision that reflects a person's risk profile and benefits. If they're concerned, we encourage them to talk to their doctor about it.”
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