First-Ever Ranking of Antidepressant Side Effects Revealed
For the first time ever, a comprehensive evaluation of the side effects caused by various antidepressants has been conducted, showing significant disparities between the drugs. The study focused on the effects experienced by patients within the first two months of starting their treatment. It was observed that some medications led to noticeable weight gain and heart rate fluctuations.
Approximately eight million individuals in the UK rely on antidepressants. The study's researchers have cautioned that the significant variation in side effects could influence patients' overall health and their ability to adhere to prescribed treatments. While they emphasize that current patients should not discontinue their treatment based on this information, they do advocate for a more personalized approach to prescribing antidepressants.
Significant Differences Between Antidepressants
"The differences between antidepressants are substantial and this is not just significant for individual patients, but also for the large number of people taking them. Even minor changes can have a big impact across the population," noted the lead researcher.
While it has been well-documented that antidepressants can impact physical health, this is the first study to provide a comprehensive comparison of these effects across different medications. The research team examined 151 studies of 30 commonly prescribed antidepressants, involving over 58,500 patients.
While not everyone experiences side effects, the study revealed some interesting findings, including:
- Patients on agomelatine for eight weeks lost an average of 2.4kg, while those on maprotiline gained nearly 2kg.
- The heart rate difference between patients on fluvoxamine and nortriptyline was 21 beats per minute.
- The blood pressure difference between patients on nortriptyline and doxepin was 11 mmHg.
Implications of the Findings
"No two antidepressants are created equal," said one of the researchers. This variation can lead to significant clinical implications, including increased risk of heart attack or stroke. Therefore, patients with the same diagnosis could benefit from different antidepressants based on their personal health circumstances and preferences.
One of the researchers emphasized that while the studies they analyzed were relatively short-term (about eight weeks), they still observed considerable changes in physical health parameters that they believe are clinically relevant.
Choosing the Right Antidepressant
The researchers provide a hypothetical example to illustrate their point. Three individuals - Sarah, John, and Jane - all have the same depression diagnosis and have been recommended antidepressants. However, they each have different concerns about potential side effects.
Sarah wants to avoid weight gain, John has high blood pressure, and Jane has high cholesterol. Based on the findings of the study, each of these individuals would be recommended a different antidepressant.
The researchers caution that it's an oversimplification to label antidepressants as good or bad. For instance, while amitriptyline can increase weight, heart rate, and blood pressure, it also helps alleviate pain and sleep difficulties.
Most Commonly Prescribed Antidepressants
The study found that the most prescribed class of antidepressants - SSRIs like paroxetine, citalopram, escitalopram, and sertraline - tended to have fewer physical side effects. Fluoxetine, another popular SSRI, was associated with weight loss and elevated blood pressure.
A researcher said it's "impossible" to determine how many of the millions of people currently on antidepressants should be on a different medication. However, he noted that there has been a push for more generic, affordable medications, resulting in 85% of antidepressant prescriptions in the UK being for just three drugs: citalopram, sertraline, and fluoxetine. He believes implementing the findings of this study could significantly change this trend, leading to more effective treatment plans for more people.
The research team is currently developing a free online tool to aid doctors and patients in choosing the appropriate medication. However, this would require a considerable shift in the healthcare culture.
Long-Term Effects Still Unknown
The study only analyzed the effects observed eight weeks after starting treatment. While the researchers expect these short-term changes to persist, they acknowledge that further testing is needed to confirm this.
An external researcher who was not involved in the study praised the findings as "novel and valuable," adding that the cumulative risks are likely to be higher in real-world settings where patients often take antidepressants for months or years, especially among those with chronic depression.