Effects of Nefazodone on Body Weight: A Pooled Analysis of Selective Serotonin Reuptake Inhibitor­ and Imipramine-Controlled Trials.
J Clin Psychiatry 2001;62(4):256-260
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Background: Evidence suggests that the newer
antidepressant drugs may differ with respect to their effects on
body weight, especially during long-term treatment. However, the
published data about treatment-emergent weight change with the
newer antidepressants are limited. Most reports of unexpected
selective serotonin reuptake inhibitor (SSRI)-associated weight
gain are anecdotal or from small controlled trials. To determine
if differences exist among the newer antidepressants, the authors
retrospectively analyzed data from clinical trials comparing
nefazodone with SSRIs and with imipramine.
Method: Weight change data supplied by
Bristol-Myers Squibb from 6 completed clinical trials comparing
the antidepressant nefazodone (N = 523) with 3 SSRIs, fluoxetine,
sertraline, and paroxetine (N = 513), as well as 3 trials
comparing nefazodone (N = 225) with the tricyclic antidepressant
imipramine (N = 224) were analyzed. In all studies, nefazodone
was found to be equal in efficacy to the comparator
antidepressants. Studies that included both acute and long-term
treatment phases were included in the analysis. Acute phases of
the trials lasted either 6 or 8 weeks, and long-term phases
varied in duration from 16 to 46 weeks. The analysis included
summarizing the number and percentage of patients in each group
with a >= 7% change in body weight from baseline at any point
in the long-term and acute phases, at endpoint, and at week 16 of
the long-term phases.
Results: Using 7% or greater weight change as
the measure of clinical significance, 4.3% of SSRI-treated
patients had lost weight at any point in the acute phase versus
1.7% of those treated with nefazodone (p = .017). However, at any
point during the long-term phase, significantly more SSRI-treated
patients than nefazodone-treated patients showed a significant
increase in body weight (17.9% vs. 8.3%; p = .003). At any point
in the acute phase, significantly more imipramine-treated
patients than nefazodone-treated patients had a 7% or greater
increase in body weight (4.9% vs. 0.9%; p = .027), and for the
long-term phase the comparison yielded 24.5% versus 9.5%. The
difference during the long-term phase was statistically
significant in women (p = .017), but not in men (p = .078) due to
the small numbers of men in each group.
Conclusion: SSRIs caused more weight loss during
short-term treatment but more weight gain during long-term
treatment. These results lend support to the observation that
some antidepressants have a greater expected risk of weight gain
than others during long-term therapy.