Metabolic Syndrome and SSRIs

A recent study (Raeder et al., Dec 2006, Journal of Clinical Psychiatry) indicated that SSRIs were associated with abnominal obesity and elevated cholesterol levels. There was a nonsignificant trend indicating that SSRIs may be associated with increased incidence of diabetes.

Which SSRIs? Citalopram (Celexa) was not associated with any of the risk factors studies, while paroxetine (Paxil) made out quite poorly. Due to a lack of large numbers of subjects on fluoxetine (Prozac), fluvoxamine (Luvox) or sertraline (Zoloft), people on these drugs were treated as one group, which was associated with increased abdominal obesity and elevated cholesterol.

Antipsychotics: Unsurprisingly, antipsychotic use was also associated with obesity and other health problems.

The authors suggest that SSRI-treated patients be monitored closely for the metabolic syndrome, which is a major risk factor for heart disease and diabetes. Sounds like a good idea.

My View on SSRIs: I’m not saying that SSRIs absolutely don’t work – they work a little bit better than a placebo. And placebo works pretty well, so you’re prescribing a nice-sized placebo effect with an SSRI.

Yet the cost is an elevated risk for suicide as well as potentially the risk for metabolic syndrome (though some research has indicated that SSRIs may actually improve metabolic health). The sexual side effects are also notable for many. The long-term outcomes with SSRIs appear poor.