Fluoxetine Versus Sertraline and Paroxetine in Major Depressive Disorder: Changes in Weight With Long-Term Treatment

Background: The effects of extended selectiveserotonin reuptake inhibitor (SSRI) treatment on weight are notwell characterized. Also unknown is whether different agents havedifferential effects. To examine these questions, we assessedweight changes in patients randomly assigned to long-termtreatment with fluoxetine, sertraline, or paroxetine.

Method: Patients (N = 284) with major depressivedisorder (DSM-IV) were randomly assigned to double-blindtreatment with fluoxetine (N = 92), sertraline, (N = 96), orparoxetine (N = 96) for a total of 26 to 32 weeks. The meanpercent change in weight was compared for each group, as was thenumber of patients who had >= 7% weight increase frombaseline.

Results: Patients (fluoxetine, N = 44;sertraline, N = 48; paroxetine, N = 47) who completed the trialwere included in these analyses. Paroxetine-treated patientsexperienced a significant weight increase, fluoxetine-treatedpatients had a modest but nonsignificant weight decrease, andpatients treated with sertraline had a modest but nonsignificantweight increase. The number of patients whose weight increased>= 7% from baseline was significantly greater forparoxetine-treated compared with either fluoxetine-treated orsertraline-treated patients.

Conclusion: Risk of weight gain during extendedSSRI treatment differs depending on which SSRI is used.