Bupropion Only Antidepressant Linked to Weight Loss

Troy Brown, RN

May 17, 2016

Bupropion is the only antidepressant associated with modest long-term weight loss, but only among nonsmokers, according to a new retrospective cohort study published recently in the Journal of Clinical Medicine.

"We found that bupropion is the only antidepressant that tends to be linked to weight loss over 2 years," study leader David Arterburn, MD, Group Health Research Institute, Seattle, Washington, said in a Group Health Research Institute news release. "All other antidepressants are linked to varying degrees of weight gain."

"Our study suggests that bupropion is the best initial choice of antidepressant for the vast majority of Americans who have depression and are overweight or obese," he added.

Only Nonsmokers Lost Weight With Bupropion

Dr Arterburn and colleagues studied the relationship between antidepressant choice and weight change over 2 years among adults with a new prescription for antidepressant therapy.

"Because one of the most commonly prescribed antidepressants, bupropion, is also used as an adjunct to smoking cessation, and smoking cessation is strongly associated with weight gain, we sought to examine the effects of this antidepressant on weight gain among smokers and nonsmokers separately," the authors write.

They conducted a retrospective electronic health record–based cohort study of adult patients who began monotherapy with second-generation antidepressant treatment between 2005 and 2009. They used fluoxetine as the reference treatment and included citalopram, bupropion, paroxetine, sertraline, trazodone, mirtazapine, venlafaxine, and duloxetine.

The researchers adjusted for potential confounders present at baseline, including age, sex, history of anxiety disorder, bipolar disorder, sleep disorder, schizophrenia and schizoaffective disorders, and smoking status at the time of beginning antidepressant treatment.

Bupropion was the only medication associated with a significantly different estimate of weight loss at 2 years when compared with fluoxetine, and this finding was seen only in nonsmokers.

After adjustment for confounders, nonsmokers who began treatment with bupropion lost, on average, 7.1 pounds compared with nonsmokers who used fluoxetine (P < .01).

The results were different in those who smoked, however. Smokers who used bupropion gained, on average, 2.1 pounds compared with smokers who used fluoxetine, although this difference was not significant (P = .33).

Those who used mirtazapine gained, on average, an estimated 11.6 pounds compared with those who used fluoxetine (P = .12). This difference was not statistically significant, probably because of the small number of patients who began mirtazapine.

And with the exception of sertraline, the remaining antidepressant-drug weight-change estimates did not differ significantly from fluoxetine. Those who used sertraline gained, on average, 5.9 pounds compared with those who used fluoxetine (P = .02).

Choose Bupropion for Nonsmokers With Obesity and No Contraindications

"Obesity and depression…commonly occur together, and adults with both conditions may have even greater health risks. The causal pathway is probably bidirectional — obese adults are at greater risk of depression and vice versa," the authors write.

But bupropion is not appropriate for all patients, including those with a history of seizure disorder, they note.

"In conclusion, we find that bupropion is the only antidepressant associated with long-term weight loss (although this effect is limited to nonsmokers)."

"Given similar efficacy for improvement in depressive symptoms across bupropion and other second-generation antidepressants, bupropion may be considered the first-line drug of choice for overweight and obese patients unless there are other existing contraindications," they surmise.

Coauthor Gregory Simon, MD, Group Health, Group Health Research Institute, and University of Washington School of Medicine, Seattle, agrees, commenting in the news release: "A large body of evidence indicates no difference in how effectively the newer antidepressants improve people's moods."

"So it makes sense for doctors and patients to choose antidepressants on the basis of their side effects, costs, and patients' preferences — and, now, on whether patients are overweight or obese," Dr Simon concluded.

The authors have disclosed no relevant financial relationships.

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J Clin Med. Published online April 13, 206. Article

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