Overview
- The network meta-analysis pooled 151 trials and 17 FDA reports, covering more than 58,000 participants and 30 drugs over roughly eight weeks.
- Average weight change spanned about 4 kg, from approximately 2.5 kg loss with agomelatine to about 1.8–2.0 kg gain with maprotiline.
- Cardiovascular effects also diverged, with heart-rate changes over 21 bpm (fluvoxamine −8 vs nortriptyline +13 to +14) and blood-pressure shifts exceeding 10 mmHg (nortriptyline around −7 vs doxepin about +5).
- Authors and clinical leaders urge shared decision-making and routine physical monitoring, stressing patients should seek advice rather than stop medication abruptly.
- Findings reflect short-term effects only, with longer-term impacts unknown, which is notable given England’s high use—about 92.6 million prescriptions for an estimated 8.89 million patients in 2024/25.