Anyone who has been prescribed medication for depression knows the long list of possible side effects: fatigue, appetite changes, headaches, and more. But these physical reactions are not the same across all medications. Recent research shows that some antidepressants can cause quick changes in weight, heart rate, and blood pressure, while others are relatively mild. The purpose of this work was to rank antidepressants based on their known side effects, specifically those that appear within the first eight weeks of starting treatment.What Are Antidepressants?Antidepressants are prescription medications used to treat conditions like depression, anxiety, chronic pain, and more by boosting brain chemicals that regulate mood. Common types include SSRIs, SNRIs, and NDRIs. They often take several weeks to show full effect. Typical side effects can include dry mouth, weight changes, and dizziness. Interestingly, new research suggests that the side effect profile can vary depending on the specific antidepressant.Types of AntidepressantsThere are several categories of antidepressant medications, as per NHS:Selective serotonin reuptake inhibitors (SSRIs): Increase serotonin levels in the brain to improve mood.Serotonin-norepinephrine reuptake inhibitors (SNRIs): Raise both serotonin and norepinephrine, helping with mood, alertness, and stress.Tricyclic antidepressants: Affect serotonin and norepinephrine like SNRIs, but also influence other parts of the body and brain.Monoamine oxidase inhibitors (MAOIs): Boost brain chemical levels by blocking an enzyme that breaks them down.NMDA receptor antagonists: Work quickly to improve mood by targeting specific brain receptors, usually given in clinics if other medications fail.Atypical antidepressants: Don’t fit neatly into other groups, each affecting brain chemicals in unique ways.Physical Side Effects Differ Across AntidepressantsMillions of adults in the U.S. rely on antidepressants for conditions such as depression and anxiety. Like all medications, these drugs can cause side effects, though the severity varies. Researchers from King’s College London and the University of Oxford examined just how differently side effects appear across 30 antidepressants, analyzing data from over 58,500 participants in more than 150 studies.“Not all antidepressants are the same when it comes to their physical side effects,” explained Toby Pillinger, an academic clinical lecturer at King’s College London. The findings, published in The Lancet, are the first to link specific physical side effects to individual antidepressants, offering potentially important guidance for doctors prescribing these medications, which are taken by up to 17% of adults in Europe and North America.Drugs reviewed included SSRIs like sertraline (Zoloft) and fluoxetine (Prozac), SNRIs like duloxetine (Cymbalta) and venlafaxine (Effexor), and NDRIs like bupropion (Wellbutrin).What the Data ShowsThe research looked at 30 commonly prescribed antidepressants across 151 studies involving over 58,500 patients. Not everyone develops side effects, but on average:Eight weeks of agomelatine use linked to a 2.4kg weight loss, whereas maprotiline led to nearly 2kg weight gain.Heart rate varied by 21 beats per minute between fluvoxamine, which slowed the heart, and nortriptyline, which sped it up.Blood pressure differed by 11 mmHg between nortriptyline and doxepin.Antidepressants: Effects on Heart Rate and Blood PressureSome medications, like fluoxetine, were linked to increased systolic blood pressure, while others, like citalopram (Celexa), were not. Citalopram was associated with slight weight loss, decreased heart rate, and systolic blood pressure, with a minor rise in diastolic blood pressure. Venlafaxine raised heart rate, while paroxetine (Paxil) caused no heart rate changes.“Clearly, no two antidepressants affect the body in the same way,” said Dr. Atheeshaan Arumuham from King’s College London. Interestingly, commonly prescribed antidepressants in the U.S., such as fluoxetine, bupropion, and sertraline, were linked to weight loss over the short-term in these trials. For reference, about 1.4 million people were prescribed citalopram last year.Antidepressants: Short-Term or Long-Term Side Effects?A limitation of this research is that the studies analyzed were relatively short, with a median treatment duration much shorter than most real-world use. It also did not assess other common side effects, including sexual dysfunction, headaches, upset stomach, and, in rare cases, agitation or suicidal thoughts. Since the focus was on the first eight weeks, further research is needed to understand long-term effects.Choosing the Right AntidepressantAs side effects differ across medications, there is no one-size-fits-all solution. Dr. Pillinger advises that selecting the right antidepressant should always be done in consultation with a qualified medical professional.
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