title: An electronic health records study of long-term weight gain following antidepressant use.
abstract: OBJECTIVE
  Short-term studies suggest antidepressants are associated with modest weight gain but little is known about longer-term effects and differences between individual medications in general clinical populations.
  
  
  OBJECTIVE
  To estimate weight gain associated with specific antidepressants over the 12 months following initial prescription in a large and diverse clinical population.
  
  
  METHODS
  We identified 22,610 adult patients who began receiving a medication of interest with available weight data in a large New England health care system, including 2 academic medical centers and affiliated outpatient primary and specialty care clinics. We used electronic health records to extract prescribing data and recorded weights for any patient with an index antidepressant prescription including amitriptyline hydrochloride, bupropion hydrochloride, citalopram hydrobromide, duloxetine hydrochloride, escitalopram oxalate, fluoxetine hydrochloride, mirtazapine, nortriptyline hydrochloride, paroxetine hydrochloride, venlafaxine hydrochloride, and sertraline hydrochloride. As measures of assay sensitivity, additional index prescriptions examined included the antiasthma medication albuterol sulfate and the antiobesity medications orlistat, phentermine hydrochloride, and sibutramine hydrochloride. Mixed-effects models were used to estimate rate of weight change over 12 months in comparison with the reference antidepressant, citalopram.
  
  
  METHODS
  Clinician-recorded weight at 3-month intervals up to 12 months.
  
  
  RESULTS
  Compared with citalopram, in models adjusted for sociodemographic and clinical features, significantly decreased rate of weight gain was observed among individuals treated with bupropion (β [SE]: -0.063 [0.027]; P = .02), amitriptyline (β [SE]: -0.081 [0.025]; P = .001), and nortriptyline (β [SE]: -0.147 [0.034]; P < .001). As anticipated, differences were less pronounced among individuals discontinuing treatment prior to 12 months.
  
  
  CONCLUSIONS
  Antidepressants differ modestly in their propensity to contribute to weight gain. Short-term investigations may be insufficient to characterize and differentiate this risk.
authors.affiliation: Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Boston2Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Blumenthal
authors.affiliation: Partners Research Computing, Partners HealthCare System, Boston, Massachusetts4Laboratory of Computer Science, Department of Neurology, Massachusetts General Hospital, Boston.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Castro
authors.affiliation: Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Boston2Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston.
authors.forename: Caitlin C
authors.initials: CC
authors.lastname: Clements
authors.affiliation: Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Boston2Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston.
authors.forename: Hannah R
authors.initials: HR
authors.lastname: Rosenfield
authors.affiliation: Partners Research Computing, Partners HealthCare System, Boston, Massachusetts4Laboratory of Computer Science, Department of Neurology, Massachusetts General Hospital, Boston.
authors.forename: Shawn N
authors.initials: SN
authors.lastname: Murphy
authors.affiliation: Depression Clinic and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.affiliation: Depression Clinic and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Weilburg
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Erb
authors.affiliation: Information Systems, Partners HealthCare System, Boston, Massachusetts.
authors.forename: Susanne E
authors.initials: SE
authors.lastname: Churchill
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Isaac S
authors.initials: IS
authors.lastname: Kohane
authors.affiliation: Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston.
authors.forename: Jordan W
authors.initials: JW
authors.lastname: Smoller
authors.affiliation: Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Boston2Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston.
authors.forename: Roy H
authors.initials: RH
authors.lastname: Perlis
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000009:adverse effects; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D015992:Body Mass Index; D016642:Bupropion / Q000009:adverse effects; D015283:Citalopram / Q000009:adverse effects; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D009661:Nortriptyline / Q000009:adverse effects; D011446:Prospective Studies; D015430:Weight Gain / Q000187:drug effects*; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D016642:Bupropion; D015283:Citalopram; D000639:Amitriptyline; D009661:Nortriptyline