Overview
- The peer‑reviewed network meta‑analysis pooled 151 randomized trials with 58,534 participants comparing 30 antidepressants over roughly eight weeks.
- Estimated averages varied widely, with about a 4 kg spread in weight change (agomelatine ≈ −2.4 kg vs maprotiline ≈ +1.8–2.0 kg) and a 21 bpm spread in heart rate (fluvoxamine ≈ −8 bpm vs nortriptyline ≈ +14 bpm).
- Selective serotonin reuptake inhibitors generally showed fewer short‑term physical changes; examples include sertraline (≈ −0.76 kg, slight pulse drop with small BP rises) and citalopram (≈ −0.65 kg, lower heart rate and systolic BP), while amitriptyline was linked to weight gain (~1.6 kg), higher heart rate (~9 bpm) and increased blood pressure.
- Authors and experts urge shared decision‑making and regular monitoring, cautioning patients not to stop medication abruptly; a free decision‑support tool is in development to help match drugs to patient priorities.
- With around 8.89 million people in England receiving 92.6 million antidepressant items in 2024/25, public‑health leaders say even modest average changes warrant routine checks and guideline updates, noting most trial data cover only short courses.