Hello Health Rounds readers! Antidepressants have long been linked to weight gain, but today we highlight a study that finds little difference between a variety of drugs. We also report on a study suggesting shingles vaccines may protect the heart and a possible advance in improving tests for sleep disorders.
Health Rounds is taking a break for the Fourth of July holiday and will return next week with important medical studies and advances.
Weight gain due to antidepressants varies only slightly
Weight gain after starting antidepressant treatment probably does not vary much by drug, according to a report published Monday in Annals of Internal Medicine (link).
Of the eight antidepressants studied, bupropion (Wellbutrin) was consistently associated with the least weight gain, the researchers said.
However, only small differences in weight changes are expected among patients taking either medication, the researchers said.
The researchers mimicked a randomized trial to compare the drugs using health data from more than 183,000 adults who began treatment with bupropion, sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), venlafaxine (Effexor), paroxetine (Paxil), or duloxetine (Cymbalta).
Zoloft – the most commonly prescribed first-line drug, used by 20 percent of participants – was associated with an average gain of nearly 0.5 pounds (0.2 kilograms) after six months.
Users of Lexapro, Paxil, and Cymbalta gained an average of 0.7 to 0.9 pounds (0.3 to 0.4 kilograms) more after six months than users of Zoloft and were 10 to 15 percent more likely to gain at least 5 percent of their baseline weight.
Wellbutrin users gained, on average, about half a pound less weight than Zoloft users, and they were 15 percent less likely to gain at least 5 percent of their starting weight.
The effects of taking Prozac on weight change were similar to those of Zoloft.
“Clinicians and patients could consider these differences when making decisions about specific antidepressants, particularly given the complex associations between obesity and depression with health, quality of life, and stigma,” the researchers said.
Shingles vaccination linked to cardiovascular benefits
A new study suggests that shingles vaccines may also provide protection against strokes and heart attacks.
The researchers compared 27,093 adults who had been vaccinated against the herpes zoster virus with five times as many similar people who had not been vaccinated. During the five-year follow-up period, the stroke rate among those vaccinated was 1.6 percent compared to 2.2 percent among those who had not received the shingles vaccine. The heart attack rate was 1.3 percent and 1.8 percent, respectively.
The study was not a randomized trial, so it cannot be proven that the vaccine actually prevented cardiovascular events.
All study participants had the oldest shingles vaccine, Zostavax from Merck & Co MRK which is no longer available in the US.
Shingrix, the currently available vaccine from GSK 
GSKis superior to the previous vaccine in preventing shingles and is recommended in the United States for all adults ages 50 and older and for younger adults who have or will have an increased risk of shingles due to immunodeficiency or immunosuppression, the authors said in a report published in the American Journal of Preventive Medicine (link).
The benefit of the older Merck vaccine in reducing the risk of stroke and heart attack was greatest in people with diabetes, but the risk was also lower in patients with other conditions such as high blood pressure, chronic obstructive pulmonary disease, high cholesterol or obesity, the researchers said.
The researchers called for similar studies on the effects of Shingrix on heart attack and stroke, but added that these findings may be relevant in parts of the world where Zostavax remains available.
Sleep monitoring with a single ECG lead
Artificial intelligence combined with a single electrocardiography electrode could replace the many cumbersome wires on the head and chest currently used to diagnose sleep disorders, researchers say.
“Our method achieves expert-level agreement with gold standard polysomnography without the need for expensive and cumbersome equipment and a clinician to interpret the test,” said study leader Bhavin Sheth of the University of Houston in a statement.
“This advance… paves the way for more accessible, low-cost sleep studies,” Sheth said.
The electrocardiography-based AI model was trained on data from 3,000 children and adults and then tested on data from another 1,000 participants, according to a report in Computers in Biology and Medicine (link).
Previously, sleep monitoring methods that did not involve monitoring the brain with electroencephalography had produced “suboptimal” results, suggesting that an EEG was always necessary, the researchers said.
The new findings challenge that notion, they added.
“Our results demonstrate that electrocardiography-based automated sleep assessment” – or cardiosomnography – can achieve performance comparable to polysomnography,” the researchers said.
Antidepressant Weight Gain: Only Small Differences Found
Weight gain after starting antidepressant treatment probably does not vary much by drug, according to a new study published in the Annals of Internal Medicine.
The research, which mimicked a randomized trial, compared eight common antidepressants using health data from over 183,000 adults. Here’s a breakdown of the findings:
- Bupropion (Wellbutrin) was consistently associated with the least weight gain.
- Sertraline (Zoloft), the most commonly prescribed first-line drug, was associated with an average gain of nearly 0.5 pounds (0.2 kilograms) after six months.
- Escitalopram (Lexapro), Paroxetine (Paxil), and Duloxetine (Cymbalta) users gained an average of 0.7 to 0.9 pounds (0.3 to 0.4 kilograms) more after six months than Zoloft users. They were also 10 to 15 percent more likely to gain at least 5 percent of their baseline weight.
- Fluoxetine (Prozac) users experienced similar weight changes as those taking Zoloft.
While Wellbutrin showed a slight advantage in weight management, the researchers emphasized that the differences were relatively small. They suggested that clinicians and patients should consider these findings when choosing antidepressants, especially given the complex relationship between obesity and depression.
Shingles Vaccination: Potential Cardiovascular Benefits
A new study suggests that shingles vaccines may offer protection against strokes and heart attacks.
The research, published in the American Journal of Preventive Medicine, compared 27,093 adults who had received the shingles vaccine (Zostavax) with a much larger control group who had not. Over a five-year period, those vaccinated had a lower rate of both strokes and heart attacks.
Here are the key findings:
| Vaccinated | Unvaccinated | |
|---|---|---|
| Stroke Rate | 1.6% | 2.2% |
| Heart Attack Rate | 1.3% | 1.8% |
It’s important to note that this study wasn’t a randomized trial, so it can’t definitively prove that the vaccine caused the observed benefits. However, the findings are intriguing and warrant further investigation, particularly with the newer Shingrix vaccine, which is considered superior to Zostavax.
Sleep Monitoring: A Single ECG Lead Could Revolutionize Diagnosis
Researchers are developing a new method for diagnosing sleep disorders using a single electrocardiography (ECG) electrode. This innovative approach, powered by artificial intelligence (AI), could potentially replace the cumbersome and expensive polysomnography (PSG) tests currently used.
Here’s why this is a significant advancement:
- Simplified process: Current PSG tests involve multiple wires attached to the head and chest, leading to discomfort and inconvenience. This new system would require only a single ECG lead, making it significantly easier for patients.
- Accessible and affordable: This technology has the potential to make sleep studies more accessible and affordable, opening up new possibilities for diagnosis and treatment.
The AI-powered system was trained on data from 3,000 individuals and then tested on a separate group of 1,000 participants. The results were comparable to traditional PSG tests, indicating that this new technology could be a viable alternative.