A review confirms major differences in the cardiometabolic side effects of 30 antidepressants
Different antidepressant drugs cause different side effects in the body, in parameters such as heart rate, blood pressure or body weight, according to a meta-analysis published by The Lancet. For example, agomelatine administration is associated with weight loss, while other molecules such as maprotiline are associated with weight gain. The research brings together 151 studies and 17 reports from the US Food and Drug Administration (FDA), including more than 58,000 people and comparing 30 antidepressant drugs with a placebo.
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Eduard Vieta
Professor of Psychiatry at the University of Barcelona, Head of the Psychiatry and Psychology Department at Hospital Clínic in Barcelona, and researcher at the Biomedical Research Centre in Mental Health (CIBERSAM)
This is a highly relevant comparative synthesis. The study is very informative and useful for updating clinical practice guidelines. Although the profile of antidepressants in terms of cardiovascular safety and tolerability was already known, the article quantifies clinical impressions and provides a quantitative and qualitative ranking that has great practical application.
Among the limitations of the study, I would highlight two: that it was not possible to perform a differential analysis by gender, which would be very interesting, and that the data on rare adverse effects are unreliable. However, the study reinforces the safety of drugs used for depression and reports on their differences with regard to possible effects on the cardiovascular system and weight, which are very relevant.
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Diego Hidalgo-Mazzei
Psychiatrist and researcher at the Bipolar and Depressive Disorders Unit of the Hospital Clínic de Barcelona
This is a methodologically sound study with a large sample size and authors of great prestige and recognized experience in network meta-analysis and psychopharmacology. The quality of the data and statistical rigor allow for reliable and valid comparisons between different antidepressants, something unusual in previous literature, which has tended to focus on specific parameters or antidepressants. This study provides a comprehensive and up-to-date overview of the physiological effects of a wide range of antidepressants, particularly cardiometabolic parameters, which is an important innovation and an advance over previous studies that were more partial or focused on a single drug or parameter.
In clinical practice in our field in Spain, the results are of enormous relevance, as they allow for more personalized prescribing of antidepressants, taking into account the somatic pathologies and comorbidities of each patient, especially cardiovascular and metabolic ones, which are also one of the main concerns in terms of adverse effects in patients. This type of evidence facilitates shared decision-making between clinician and patient, allowing for a more accurate assessment of the risk-benefit balance of each treatment.
Toby Pillinger et al.
- Research article
- Peer reviewed
- People
- Meta-analysis
