Moss Lauren, Laudenslager Marci, Steffen Kristine J, Sockalingam Sanjeev, Coughlin Janelle W
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA.
Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA.
Curr Obes Rep. 2025 Jan 3;14(1):2. doi: 10.1007/s13679-024-00598-5.
To highlight recent research on antidepressant use and weight change and explore best clinical practices for reducing weight gain and obesity risk in individuals with depression.
Research on antidepressant use and weight gain suggests that genetic and biological factors including metabolizer phenotypes and inflammation can help to predict an individual's threshold for weight change among specific agents. For individuals with increased susceptibility to metabolic complications, medications including bupropion, fluoxetine, and newer agents (e.g., gepirone) have shown to be efficacious in improving depressive symptoms while concurrently reducing metabolic risks. Additional areas of focus following antidepressant related weight gain include switching to a weight neutral drug alternative, integrated behavioral interventions, and/or pharmacotherapy including GLP-1 receptor agonists (e.g., metformin, liraglutide). Individuals experiencing depression are at heightened risk of metabolic disorders and weight gain, which may be further exacerbated by antidepressant treatment. The increased support of weight neutral antidepressant agents in addition to innovative lifestyle interventions, breakthroughs in drug mechanisms, anti-obesity medications and overall familiarity with the side effects of each antidepressant class will help clinicians make appropriate decisions when treating patients with depression.
强调近期关于抗抑郁药使用与体重变化的研究，并探讨降低抑郁症患者体重增加和肥胖风险的最佳临床实践。
关于抗抑郁药使用与体重增加的研究表明，包括代谢酶表型和炎症在内的遗传和生物学因素有助于预测个体在特定药物作用下的体重变化阈值。对于代谢并发症易感性增加的个体，包括安非他酮、氟西汀和新型药物（如吉哌隆）在内的药物已显示出在改善抑郁症状的同时降低代谢风险的效果。抗抑郁药相关体重增加后的其他关注领域包括改用对体重无影响的药物替代方案、综合行为干预和/或药物治疗，包括胰高血糖素样肽-1受体激动剂（如二甲双胍、利拉鲁肽）。患有抑郁症的个体代谢紊乱和体重增加的风险更高，而抗抑郁药治疗可能会进一步加剧这种情况。除了创新的生活方式干预措施外，对体重无影响的抗抑郁药的支持增加、药物作用机制的突破、抗肥胖药物以及对各类抗抑郁药副作用的全面了解，将有助于临床医生在治疗抑郁症患者时做出适当的决策。
