Endo Sdm Antidepressant

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name: endo-sdm-antidepressant
description: Recommends a shared decision‑making process that provides patients with quantitative estimates of the expected weight effect of antidepressants to inform drug choice, also considering expected treatment length. Triggers include clinician questions such as ‘How should I discuss weight‑change risks with this patient starting an antidepressant?’ or ‘What tool can I use to show expected weight impact of sertraline vs bupropion?’.
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# Shared decision‑making for antidepressants with weight‑effect estimates

## STEP 1 — Gather Information
Collect depression diagnosis, baseline weight/BMI, comorbidities, prior antidepressant trials, expected treatment duration, and patient’s specific concerns or preferences regarding weight change.

## STEP 2 — Rule In / Rule Out
If antidepressant therapy is indicated **and** the patient expresses concern about weight‑related side effects, proceed to weight‑effect discussion; otherwise, prescribe using standard efficacy/safety criteria without a formal weight‑effect conversation.

## STEP 3 — Classify or Stratify
Stratify candidate antidepressants by published mean weight change (e.g., bupropion ≈ –1 kg, sertraline ≈ +0.5 kg, paroxetine ≈ +1–2 kg) into categories of weight loss, neutral, or gain, adjusting estimates for the anticipated length of treatment.

## STEP 4 — Decide
Engage in shared decision‑making: present the quantitative weight‑effect estimates alongside efficacy, tolerability, and other side‑effect profiles; elicit patient values; select the antidepressant that best aligns with clinical goals and patient preferences; document the discussion and chosen agent.

## Clinical Guardrails / Mimics / Pitfalls
Do not let weight‑effect estimates override efficacy or safety; avoid presenting mean changes as guaranteed individual outcomes; do not omit discussion of other adverse effects; do not use the estimates to pressure the patient toward a particular drug.

## Concrete Clinical Example
A 45‑year‑old woman with MDD, BMI 31 kg/m², worries about weight gain and plans 6 months of treatment. The clinician shares estimates: bupropion –1 kg (loss), sertraline +0.5 kg (small gain), paroxetine +1.5 kg (moderate gain). After reviewing efficacy and side‑effects, she chooses bupropion.

**Source:** Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2015, DOI: 10.1210/jc.2014-3415