Association of first-line antidepressants and incident adverse metabolic effects

Clinical Inquiries question: Are first-line antidepressants associated with incident adverse metabolic effects in adults? Evidence-based answer: Selective serotonin reuptake inhibitors (SSRIs) and bupropion statistically significantly increase the risk of incident type 2 diabetes mellitus (T2DM) (strength of recommendation [SOR] B: based on a systematic review and meta-analysis, and a prospective cohort study). Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors (SNRIs) are associated with weight gain, although there is mixed evidence on both its clinical significance and to what degree depression might be a confounding variable (SOR B: based on 3 prospective cohort studies). Evidence suggests there is an association between the development of metabolic syndrome and SSRIs, but it might be dependent upon the choice of diagnostic criteria and SSRI serum concentration or dose (SOR B: based on 2 retrospective cohort studies). No association between SNRIs, bupropion, and incident hypertension persists after adjustment for demographic characteristics, socioeconomic factors, and comorbidities. No association was observed between SSRIs and incident hypertension (SOR B: based on a retrospective cohort study).Frances K. Wen, PhD; Kimberly Crosby, PharmD; Barbara H. Miller, MD; Michael Rommen, MD; Samuel J. Kirzner, MPH; Toni Hoberecht, MA, MLIS, AHIP; Alyssa Migdalski, MLIS.Dr Wen is Professor, Director of Research, and Behavioral Health Director in the Department of Family and Community Medicine at the University of Oklahoma-Tulsa. Dr Crosby is Associate Professor in the Department of Family and Community Medicine at the University of Oklahoma-Tulsa. Dr Miller is a family physician in Joplin, Mo. Dr Rommen is a family physician in Monroe, La. Mr Kirzner is Double Up Program Manager at Hunger Free Oklahoma in Tulsa. Ms Hoberecht is Technical Services Librarian and Ms Migdalski is Reference and Instruction Librarian in the Schusterman Library at the University of Oklahoma-Tulsa.Includes bibliographical reference