Key Takeaways
Extended Takeaways
- The review separated acute treatment from maintenance treatment because weight effects changed over time; fluoxetine showed early weight loss that did not persist, whereas paroxetine shifted from marginal weight loss acutely to weight gain in the medium-long term.
- For patients likely to need long-term antidepressant treatment, short-term tolerability can be misleading: agents with little or no acute weight signal, including paroxetine, may still become problematic after prolonged exposure, with significant weight gain emerging after 8 months of treatment.
- Bupropion was the only antidepressant reported to maintain a significant weight-lowering effect beyond the acute phase, making it clinically distinct from SSRIs and SNRIs whose early weight loss generally did not persist.
- Imipramine showed no significant effect on body weight in either acute or maintenance analyses, underscoring that tricyclic antidepressants should not be assumed to have uniform weight-gain liability.
- The analysis included 116 studies, but only 30 were placebo controlled; clinicians should interpret smaller drug-specific findings cautiously, especially where the authors noted high heterogeneity, possible publication bias, or very limited maintenance data.
