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Study indicates paroxetine, sertraline, citalopram, and escilatopram tend to increase factors leading to metabolic dysfunction and diabetes. Psychiatry Investig. 2013 Jun;10(2):148-54. doi: 10.4306/pi.2013.10.2.148. Epub 2013 May 30. Relationship between SSRIs and Metabolic Syndrome Abnormalities in Patients with Generalized Anxiety Disorder: A Prospective Study. Beyazyüz M1, Albayrak Y, Eğilmez OB, Albayrak N, Beyazyüz E. Abstract and full free text at http://www.ncbi.nlm.nih.gov/pubmed/23798963 OBJECTIVE: SSRIs are some of the most widely prescribed medications in the world. In addition to their effectiveness, SSRIs were reported to be associated with the side effects of weight gain, sexual dysfunction, drug interactions, extrapyramidal symptoms and discontinuation symptoms. However, the effects of SSRIs on metabolic parameters are poorly understood. METHODS: This study aims to describe the effects of SSRIs on the metabolic parameters of drug-naive first episode patients with generalized anxiety disorder. Ninety-seven female patients aged 20-41 years without any metabolic or psychiatric comorbidity were included in the study. Fluoxetine, sertraline, paroxetine, citalopram and escitalopram were randomly given to the patients. Metabolic parameters, including BMI, waist circumference and the levels of fasting glucose, total cholesterol, triglyceride, HDL, LDL and blood pressure, were measured before and after 16 weeks of treatment. RESULTS: In the paroxetine group, there was a significant increase in the parameters of weight, BMI, waist circumference, fasting glucose, total cholesterol, LDL and triglyceride after 16 weeks of treatment. There were significant increases in the levels of triglyceride in the citalopram and escitalopram groups. In the sertraline group, the total cholesterol level increased after treatment. In the fluoxetine group, there were significant reductions in the parameters of weight, total cholesterol and triglyceride. CONCLUSION: To our knowledge, this study is the first to prospectively describe metabolic syndrome abnormalities in patients with first episode generalized anxiety disorder. Although the effectiveness of the different SSRIs is similar, clinicians should be more careful when prescribing SSRIs to patients who have cardiac risk factors. Larger and lengthier controlled clinical trials are needed to explore the associations between SSRI use and metabolic syndrome. From the paper: .... In the literature, there is only one study that investigated whether subjects taking antidepressants were more likely to have elements of metabolic syndrome compared to subjects who were not taking psychotropic agents. In this cross sectional study, an association was reported between SSRI use and diabetes. In the subgroup analyses, paroxetine use was found to be markedly associated with both abdominal and general obesity. Citalopram was reported to be safe in terms of metabolic syndrome. However, fluoxetine, fluvoxamine and sertraline were assessed as a mixed group and have been reported to be associated with abdominal obesity and hypercholesterolemia.18 In our study, fluoxetine was found to be the safest SSRI in terms of metabolic syndrome. Furthermore, at the end of the follow-up period, there were significant reductions in the parameters of weight, BMI, waist circumference, total cholesterol, LDL and TG. Our finding is partially in contrast to that of Reader and et al., who found that fluoxetine was associated with abdominal obesity and hypercholesterolemia.18 These contrasting findings are most likely due to differences in the methodologies of the studies. However, a recent meta-analysis that investigated the metabolic effects of fluoxetine in patients with type-2 DM suggested that fluoxetine was associated with weight loss and reductions in the fasting glucose level, HbA1c and TG.47 Our findings are in line with the results of this recent meta-analysis. Our results showed that only the lipid profile of the patients was changed after treatment with citalopram and sertraline. While the total cholesterol level increased in the sertraline group, the level of TG was significantly elevated in the citalopram group. These findings partially replicated the findings of Reader et al.; however, citalopram cannot be described as purely safe in terms of its effects on lipid profile.18 To our knowledge, our finding is the first to describe an association between citalopram use and increased serum TG. Escitalopram, which has a similar molecular structure to that of citalopram, was found to significantly increase serum TG levels after sixteen weeks of use. However, the waist circumference of these patients was reduced after treatment. Thus, the metabolic effects of citalopram and escitalopram should be considered to be independent from weight gain. At the end of the follow-up period, paroxetine affected all the parameters of metabolic syndrome except serum HDL level and blood pressure. Our findings replicated the findings of Reader et al.18 and Fava et al.,48 in which weight gain was reported 26 and 32 weeks after paroxetine treatment. Furthermore, in a recent meta-analysis by Serretti and Mandelli,49 it was reported that paroxetine use was associated with weight gain. Thus, our findings also supported the studies data in which paroxetine was reported to be associated with weight gain. However, the effects of paroxetine on metabolic parameters cannot be clearly explained. ....