Antidepressants Driving Obesity, Again
The vast majority of oral medicines for depression lead to risk of weight gain.
The Frontier Psychiatrists is on a tiny crusade. This newsletter wants the world to know that sickness and suffering should can get better. That comes, if one is an adult, with the acknowledgment of risk. As a physician, it's my job to both meaningfully address the problem my patients come to me seeking relief from and be mindful of the risks. One of those risks is weight gain. It's obvious when we're talking about the massive weight gain that we see from second generation and antipsychotic medications, which can be on the order of 2 kg a month for a medicine like olanzapine. However, when it comes to oral antidepressants, for too long, we have downplayed the risks. I've already written about how the use of oral antidepressants in children can lead to being shorter than the child might have otherwise been. The data suggests than antihistamines “for sleep”—those can increase the risk of weight gain, too. I have been on the antidepressants-drive-weight-gain “beat” as a reporter for a while.
Today, we have yet another large data set published in the Annals of Internal Medicine that shines a light on to the pernicious risks of weight gain in oral antidepressants.
Before I dive into that data, let me remind my readers that they all medicines are not the only way to treat depression. In fact, I'm writing this from Kobe, Japan. Why, one might ask, is Dr. Muir in Japan? Does he love expensive beef? No, not at all, I'm actually a pescatarian. I'm here because there's a conference at which I'm presenting some data. It's called Brain Stimulation! It’s very science-y. But at this meeting, a bunch of scientist, many of whom are also practicing physicians, will be sharing data around the role of non-medication treatments for brain disorders. The most commonly treated brain disorder with stimulation of the brain is depression. It's the very same disorder that these oral medication's—I'm bashing—do both less than awesome job treating, and cause adverse effects. We don't have to keep using oral medication's as the only way we can treat brain disorders. We can use brain stimulation instead. We don't have to consider psychiatry a discipline solely for psychopharmacologists. Psychiatry could be a discipline in which people come to a doctor for help with their problems, and the doctor prescribes a treatment. And that treatment? Wait for it. It might not be a pill. It might be something else entirely. It might be a treatment that stimulates the brain, and relieves the depression, and does not include a daily oral medication that causes risk of weight gain, movement disorders, emotional blunting, sexual side effects, and a range of other problems.
We could use brain stimulation as a first line treatment, we could do research about brain stimulation as a first line treatment, we'd have to pay for it though.
But let's take a look at the following data on oral antidepressants, currently considered a first line treatment, and consider, while we're doing it, whether we want this state of affairs to continue. Should people have to take a medication that's gonna make them at risk to gain massive amounts of weight in order to qualify for treatments that are safer, and plausibly more effective? Why do we have to use the unlikely to work treatments with worse side effects first? We don't.
Thank you for joining my rant, or TEDTalk, depending on your perspective.
Medication-Induced Weight Change Across Common Antidepressant Treatments: A Target Trial Emulation Study
This large observational study included 183,118 patients from 8 large US health systems. They pulled data on the prescribing of…
initiation of treatment with sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, or venlafaxine.
They authors started with an assumption: