Obesity, Dyslipidemia, and Diabetes With Selective Serotonin Reuptake Inhibitors: The Hordaland Health Study

Maria B. Raeder, M.D.; Ingvar Bjelland, M.D., Ph.D.; Stein Emil Vollset, M.D., Dr.P.H.; and Vidar M. Steen, M.D., Ph.D.

Objective: This study aimed to examine whether subjects taking selective serotonin reuptake inhibitors (SSRIs) are more likely to have elements of the metabolic syndrome compared with those taking no psychotropic drugs. For comparison, we also studied subjects taking antipsychotic drugs.

Method: We used data from The Hordaland Health Study '97-'99, a general community cross-sectional health survey including 25,315 subjects aged 40 to 49 and 70 to 74 years. For the groups studied, we estimated prevalence and odds ratios (ORs) for obesity, hypercholesterolemia, low high-density lipoprotein cholesterol, hypertriglyceridemia, and diabetes.

Results: We observed an association between use of SSRIs as a group (N = 461) and abdominal obesity (OR = 1.40, 95% CI = 1.08 to 1.81) and hypercholesterolemia (OR = 1.36, 95% CI = 1.07 to 1.73) after adjusting for multiple possible confounders. There was also a trend toward an association between SSRI use and diabetes. In a subgroup analysis of subjects taking SSRIs, the use of paroxetine (N = 187) was markedly associated with both general and abdominal obesity but not with hypercholesterolemia. In contrast, the use of citalopram (N = 142) was not associated with any of the metabolic outcome variables, while the use of any other SSRI (sertraline, fluoxetine, or fluvoxamine) (N = 131) as a mixed subgroup was associated with both abdominal obesity and hypercholesterolemia. We also replicated the previously reported associations between use of antipsychotics and obesity and metabolic disturbances.

Conclusion: We have shown that use of at least some SSRIs is associated with clinical and biochemical elements of the metabolic syndrome. Our data indicate differences in the metabolic side effect profile among various SSRI drugs, although treatment bias might have influenced these results. We suggest that patients taking SSRIs be carefully monitored for obesity and dyslipidemia.

(J Clin Psychiatry 2006;67:1974-1982)

Received Oct. 30, 2005; accepted May 17, 2006. From Dr. Einar Martens' Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Helse Bergen HF, Haukeland University Hospital, and the Department of Clinical Medicine and Bergen Mental Health Research Center, University of Bergen (Drs. Raeder and Steen); the Department of Child and Adolescent Mental Health Services, Haukeland University Hospital (Dr. Bjelland); and the Department of Public Health and Primary Health Care, Section for Epidemiology and Medical Statistics, University of Bergen (Dr. Vollset), Bergen, Norway.

Supported by research grants from Helse Vest RHF, the Research Council of Norway ("Center for grunnleggende sykdomsmekanismer"), and the Dr. Einar Martens Fund (Dr. Bjelland).

The funding sources had no involvement in this study. The data collection was conducted as part of HUSK (The Hordaland Health Study '97-'99) in collaboration with the Norwegian National Health Screening Service.

Dr. Steen has received grant/research support from the Lundbeck Foundation and serves on the speakers/advisory board of AstraZeneca. Drs. Raeder, Bjelland, and Vollset report no additional financial or other relationships relevant to the subject of this article.

The authors thank Alv A. Dahl, M.D., Ph.D., University of Oslo, Oslo, Norway, for allowing them to use the Hospital Anxiety and Depression Scale data collected in the Hordaland Health Study.

Corresponding author and reprints: Maria B. Raeder, M.D., Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021 Bergen, Norway (e-mail: maria.rader@uib.no).