Comparative BMI-z Changes With Initiation and Adherence to Antidepressant Medications Among Youth.

OBJECTIVE: To estimate effects of initiating and subsequently adhering to different antidepressant medications on average BMI-z (a standardized measure of BMI relative to peers of the same age and sex) changes among youth by emulating a target trial. METHOD: We analyzed electronic health records (2010-2019) from 11 US health care systems, including 67,039 patients aged 5 to <19.5 years. Using prescription data, we assessed initiation and adherence to sertraline, fluoxetine, escitalopram, citalopram, or bupropion. The primary outcome was mean 12-month BMI-z change; the secondary outcome was 6-month change. We applied inverse probability weighting of marginal structural models to estimate population-level effects, adjusting for baseline and time-varying covariates. We estimated both absolute and sertraline-relative BMI-z changes. Secondary analyses evaluated effects of medication initiation alone, regardless of adherence. RESULTS: At 12 months, we estimated a mean BMI-z gain of 0.10 units (95% CI = 0.02, 0.16) for sertraline, 0.18 (95% CI = 0.01, 0.32) for citalopram, 0.18 (95% CI = 0.07, 0.27) for escitalopram, 0.18 (95% CI = 0.11, 0.23) for fluoxetine, and -0.06 (95% CI = -0.23, 0.09) for bupropion, had all patients initiated and adhered to these medications. When compared to sertraline, initiation and adherence to bupropion resulted in a lower mean BMI-z of -0.15 (95% CI = -0.32, 0.02). No other medications were associated with statistically significantly different BMI-z changes compared to sertraline. The results were similar for 6-month outcomes. Results of initiation-only analyses were consistent with these results, although the effect estimates were attenuated. CONCLUSION: Among youth, initiation and adherence to bupropion was not associated with 12-month BMI-z change, although 4 other most common antidepressants were associated with small increases in BMI-z over this time. Clinicians should consider these differences when prescribing antidepressants to youth, alongside US Food and Drug Administration approvals, clinical guidelines, and evidence of safety and efficacy.

Duke Scholars

Author William Schuyler Jones Medicine, Cardiology