Antidepressants differ significantly in side-effects, UK research finds
A major new UK-study has revealed that not all antidepressants (ADs) are created equal — particularly when it comes to their physical side-effects such as weight change, heart rate and blood pressure. With over 58,000 people across 151 clinical trials analysed, the findings show meaningful differences between commonly used antidepressants.
Key findings
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Researchers led by King’s College London and the University of Oxford compared 30 antidepressants across 151 studies, involving more than 58,000 patients.
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Over about eight weeks of treatment, they found up to 4 kg difference in average weight change depending on the drug: e.g., those on Agomelatine lost an average ~2.5 kg, while those on Maprotiline gained ~2 kg.
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Heart-rate and blood-pressure changes also varied: one drug showed an 8 beats-per-minute drop in heart rate, another showed a 14 bpm increase; blood pressure variation spanned over 10 mmHg.
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The class of selective serotonin reuptake inhibitors (SSRIs), which are often first-line treatment, showed fewer physical side-effects compared with older tricyclics and other agents.
Why this matters
For patients and clinicians alike, this study underlines an often-overlooked fact: choice of antidepressant matters, not just for mood improvement, but for physical health too. Many patients—and their doctors—treat all antidepressants as broadly similar, but the evidence now says otherwise.
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Weight gain: Can worsen self-esteem, metabolic health, and adherence to treatment.
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Heart rate/blood pressure changes: Can be particularly relevant for patients with cardiovascular risk or other health conditions.
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Treatment adherence: Physical side‐effects are one reason people stop taking their medication—undermining the benefit for mental health.
One of the senior authors, Dr Toby Pillinger (King’s IoPPN), noted: “While many people benefit from antidepressants, these drugs are not identical – some can lead to meaningful changes in weight, heart rate and blood pressure in a relatively short period.”
Implications for practice
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Shared decision-making: Patients should be informed about the physical side-effect profiles of different antidepressants, and involved in choosing the best fit for their situation.
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Tailored prescribing: For patients with existing weight, metabolic or cardiovascular issues, the study suggests that extra attention is needed when choosing an antidepressant.
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Monitoring: Especially in the first weeks of treatment, keep track of weight, heart rate and blood pressure. The study shows changes can occur quickly.
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Guideline updates: Researchers urge that clinical prescribing guidelines be updated to reflect these differences in side-effect profiles.
A note of caution
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The study mostly reviews the first eight weeks of treatment; long-term side-effects remain less clear.
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The findings do not mean antidepressants should be avoided—rather, the right drug should be matched to the right person.
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Individual responses vary. One size does not fit all in antidepressant therapy.
What you should ask your doctor
If you or someone you know is being prescribed an antidepressant, here are some helpful questions:
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“Which antidepressant are you choosing and why—from a side-effect perspective?”
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“Could we discuss the risks of weight gain, heart rate and blood pressure changes with this drug?”
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“How will we monitor physical side-effects, and what will we do if unwanted effects show up?”
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“Is there an alternative with fewer physical side‐effects if this one causes problems?”
Conclusion
This new research serves as a wake-up call: it’s not enough to consider only the mental-health benefits of antidepressant medication. Physical side-effects are real, variable and consequential. The good news? When you and your clinician are aware of the differences between drugs, you can make smarter, more personalised choices—and perhaps improve both your mental and physical health outcomes.
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