The effects of antidepressants on cardiometabolic and other physiological parameters: a systematic review and network meta-analysis

作者：Toby Pillinger, Atheeshaan Arumuham, Robert A. McCutcheon, Enrico D’Ambrosio, Georgios Basdanis, Marco Branco, Richard D. Carr, Valeria Finelli, Toshi A. Furukawa, Siobhan Gee, Adrian Heald, Sameer Jauhar, Zhefu Ma, Valentina Mancini, Calum D. Moulton, Georgia Salanti, David Taylor, Anneka Tomlinson, Allan H. Young, Orestis Efthimiou, Oliver Howes, Andrea Cipriani · 发表于：The Lancet · 年份：2025 · DOI：10.1016/s0140-6736(25)01293-0 · 被引用次数：43 · 研究领域：Treatment of Major Depression、Neurotransmitter Receptor Influence on Behavior、Heart Rate Variability and Autonomic Control

BACKGROUND: Antidepressants induce physiological alterations; however, the degree to which these occur in treatment with various antidepressants is unclear. We aimed to compare and rank antidepressants based on physiological side-effects by synthesising data from randomised controlled trials (RCTs). METHODS: We searched MEDLINE, EMBASE, PsycINFO, ClinicalTrials.gov, and the US Food and Drug Administration (FDA) website from database inception to April 21, 2025. We included single-blinded and double-blinded RCTs comparing antidepressants and placebo in acute monotherapy of any psychiatric disorder. We did frequentist random-effects network meta-analyses to investigate treatment-induced changes in weight; total cholesterol; glucose; heart rate; systolic and diastolic blood pressure; corrected QT interval (QTc); sodium; potassium; aspartate transferase (AST); alanine transaminase (ALT); alkaline phosphatase (ALP); bilirubin; urea; and creatinine. We did meta-regressions to examine study-level associations between physiological change and age, sex, and baseline weight. We estimated the correlation between depressive symptom severity change and metabolic parameter change. FINDINGS: Of 26 252 citations, 151 studies and 17 FDA reports met inclusion criteria. The overall sample included 58 534 participants, comparing 30 antidepressants with placebo. Median treatment duration was 8 weeks (IQR 6·0-8·5). We observed clinically significant differences between antidepressants in terms of ...