Does the Choice of Antidepressants Affect Health? New Research Reveals Diversity in Drug Side Effects: A "Physical Side Effect Map" of 30 Antidepressants

Introduction: What Happens Beyond "Effectiveness"

Antidepressants have alleviated the suffering of depression and anxiety disorders, saving many lives. However, recent evidence suggests that the "differences in physical side effects between medications" are more significant than previously imagined. A large-scale analysis reported by the NYT's Well section on October 21, 2025, highlighted that even in the short term (within weeks of starting treatment), there are clear differences in changes in weight, blood pressure, heart rate, etc., between drugs, making it accessible to the general public and sparking widespread debate.Bluesky Social

What's New: Network Meta-Analysis of 30 Types × Approximately 58,000 People

The latest systematic review/network meta-analysis published in the medical journal 'The Lancet'compared the short-term effects on the metabolic and cardiovascular systems (weight, blood pressure, heart rate, blood sugar, lipids, etc.)of 30 types of antidepressants, 151 clinical trials, and over 58,000 people. The results showed that the effects vary by drug, with some increasing, some decreasing, and some showing little change, confirming clinically meaningful differences.The Lancet

Differences Visible in "Weeks"

According to the research team and university announcements, some medications show significant physical changes within just a few weeks of starting, while others remain almost neutral. There are also recommendations to update guidelines to reflect differences between drugs.kcl.ac.uk

Perceiving It as "Profile Differences" Rather Than "Danger vs. Safety"

The important perspective is that antidepressants are neither "dangerous" nor "completely safe"; each has its own unique side effect profile. For example, observational and experimental studies present conflicting findings on cardiovascular effects. Some studies suggest a potential decrease in cardiovascular risk with SSRIs, while others report an increased risk of sudden death with long-term use, and basic research points to changes at the myocardial cell level. The conclusion cannot be simplified, and interpretations vary based on patient background, duration, and drug class.atherosclerosis-journal.com

Reactions on Social Media: Between Experience and Science

Following the NYT post and related reports, diverse voices emerged on social media. Here, we summarize the main points of public threads (without personal identifying information).

• Experiences of Blood Pressure and Heart Rate: Sharing experiences of feeling an increase in blood pressure with venlafaxine (SNRI). Although not as rapid as case reports suggest, a slight increase is felt.Reddit

• Reactions to Risk Reports: In response to news about the risk of sudden cardiac death, **"Caution is needed for long-term users, but there are benefits. Discuss individually", say the cautious, while others voice "It's still scary."**Reddit

• The "Range" of Side Effects: **"Side effects such as sexual function, gastrointestinal, and sleep vary greatly among individuals," say both clinical and patient comments. The shared realization that **"Even among SSRIs, the effects and side effects vary widely"** gained traction.Reddit

• How to View Withdrawal Symptoms: **"Withdrawal occurs in some people but severe cases are few," according to recent systematic reviews, while others argue that **"Research suggesting nearly half suffer is closer to my experience," highlighting the importance of updating information and individual responses.The Guardian

Implications for Practice: Prescription, Monitoring, Explanation

1. Take Baseline "Physical Indicators" During Initial Evaluation
   Record weight, blood pressure, heart rate, and metabolic indicators (blood sugar, lipids) before introduction. Considering the profile differences between drugs, re-measure a few weeks after starting to make early corrections.The Lancet

2. Drug Selection Based on "Symptoms × Comorbidities × Side Effect Profile"
   Distribute medications based on individual patient conditions such as anxiety dominance, hypersomnia/overeating, hypotension tendency, cardiovascular risk, etc. Recently, research attempts to analyze factors for SSRI/SNRI distribution using explainable AI have emerged.

3. Risk Assessment and "Exit Strategy" for Long-Term Use
   Regularly review the potential increase in cardiovascular risk with long-term use. When stopping or reducing, standardize with a gradual reduction plan and education on withdrawal symptoms.European Society of Cardiology

4. Provide Information with Both "Expectations and Uncertainty"
   Clearly explain that both effects and side effects have significant individual differences, that some drugs can affect physical indicators even in the short term, and that there are **alternative options (other drugs, combinations, non-drug)** available.The Lancet

Frequently Asked Questions (Simplified Version)

Q. Are there drugs that "quickly increase weight" or "are less likely to increase weight"?
A. Meta-analyses suggest differences in the direction of weight change even in the short term. However, individual differences are significant, and lifestyle, concomitant medications, and dosage also affect it. Baseline measurement and checking a few weeks later are important.The Lancet

Q. I'm worried about blood pressure and heart rate. Should I measure them at home?
A. Monitoring using home blood pressure monitors or wearables is useful. Record for a few weeks after starting, and if abnormalities persist, consult your doctor.medicalxpress.com

Q. What about long-term heart risks?
A. Observational studies and reports indicate an increased risk of sudden death over the long term, but the causality is not straightforward. Weigh the benefits against comorbidities, and conduct regular reviews.European Society of Cardiology

Q. How often do withdrawal symptoms occur?
A. Recent large-scale reviews report about 15% (severe cases about 3%), while others estimate over 40%, showing variability between studies. Gradual reduction and prior explanation are key.The Guardian

Conclusion: Not Just Lip Service to "Personalization"

The evidence that the short-term physical impacts of drugs differ clearly reaffirms that both prescription and follow-up cannot be "uniform." **Measure, confirm, and adjust if it doesn't fit.** This common sense should be accelerated with both guidelines and field practice. The NYT Well report played a role in visualizing the individuality of side effects as a public concern, putting pressure on the medical field for accountability and offering options.Bluesky Social