Monitoring SSRI-Treated Patients for Weight Gain and Cholesterol Elevation

Editor, Primary Psychiatry and Psychiatry Weekly, Professor of Psychiatry, New York University School of Medicine

By now, as a result of recent FDA advisories and label changes to the atypical antipsychotic agents, most clinicians and many in the general public are aware of the possibility of weight gain and diabetes associated with antipsychotics. By comparison, the metabolic effects of the SSRIs, the most prescribed antidepressants/anxiolytics, remain under-recognized by many prescribers and patients. There have been very few studies addressing this issue.

SSRIs and Weight Gain

In 1998, Dr. David Ginsberg and I published an article in Primary Psychiatry that reported numerous cases of significant weight gain among patients being treated with SSRIs (Sussman N, Ginsberg DL. Weight gain associated with SSRIs. Primary Psychiatry 1998; 5:28-37). We described these cases as a paradox, because at the time, the conventional wisdom was that these drugs were more likely to be weight neutral or to cause modest weight loss.

A review of the literature, however, found that there were a small number of case reports that were consistent with our observations that a weight gain of >20 pounds was far more common than clinical trials and communications from pharmaceutical companies indicated.

Metabolic Syndrome

A newly published study from Norway examines the nature and risk of SSRI-treated patients developing elements of the so-called metabolic syndrome (Raeder MB, Bjelland I, Vollset SE, Steen VM. Obesity, dyslipidemia, and diabetes with selective serotonin reuptake inhibitors: the Horland Health Study. J Clin Psychiatry 2006; 671974-1982). The study included ~25,000 patients in a Norwegian county. From this group, 461 subjects were identified who were taking an SSRI without concomitant TCAs, antipsychotics, or lithium. The investigators found the following:

A subgroup analysis of differences among the various SSRIs found that the prevalence of obesity was greater among paroxetine-treated patients (19.3%) than those using citalopram (11.3%) and a “mixed group” taking sertraline, fluoxetine, or fluvoxamine (15.4%).

Although the numbers involved were small, the authors report there was a trend in the data “toward an association between SSRI use and diabetes.” The use of paroxetine “was strongly associated with general and abdominal obesity and was borderline significantly associated with diabetes.”

This study is the first to show that obesity and hypercholesterolemia may be adverse effects of SSRI use. The risk, however, is not as great as that found with atypical antipsychotic use.

Disclosure: Dr. Sussman has received honoraria from AstraZeneca, Bristol-Myers Squibb, and GlaxoSmithKline.