Association between selective serotonin reuptake inhibitors use and long-term metabolic effects in adolescence : a propensity score matched cohort study

Purpose: To investigate the association between selective serotonin reuptake inhibitor (SSRI) use and the incidence of metabolic adverse effects in an adolescent population. Methods: This was a retrospective cohort study of adolescent patients (age 11-21 years) with a mental health disorder (including anxiety disorders, depression, obsessive compulsive disorder, and post-traumatic stress disorder) in the TriNetX research network from January 1, 2003 and December 31, 2017. The index event was defined as the first instance of a mental health disorder diagnosis. Patients were stratified by SSRI use or non-use. Propensity score matching was used to adjust for potential confounding variables, such as age, gender, race, and other conditions. Outcomes were analyzed 3 to 5 years after the index event through December 31, 2022; this included documented BMI > 30 kg/m², diagnosis of diabetes and other metabolic diseases, and associated laboratory tests and medications. Results: A total of 172,478 adolescent patients met inclusion criteria. After propensity score matching, 37,808 patients were included in each group. Baseline characteristics were similar between groups. Patients were predominantly female (64%) and white (72%) with a mean age of 16. The mean body mass index was 24 kg/m² (SD 6.07) in the SSRI group and 24.2 kg/m² (SD 6.08) in the non-SSRI group. The incidence of being overweight and obesity was higher in the SSRI group (36.0 per 1000 patients) compared to the control group (31.1 per 1000 patients) during follow up (p<0.0001). No significant differences were found between groups in the incidence of other metabolic diseases or laboratory test results. Conclusions: This retrospective cohort study suggests an association between SSRI use and an increased incidence of obesity, but no difference in diabetes and metabolic disorders. While the findings suggest that this specific treatment does not increase metabolic risk, it is important to continue monitoring for potential long-term effects.