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In depression, the inflammatory phenotype is particularly associated with atypical symptoms, including increased sleep and appetite, potentially leading to weight gain and local inflammation and macrophage infiltration in the adipose tissue, creating a self-perpetuating inflammatory loop [81]

Importantly, tricyclic antidepressants, especially amitriptyline and nortriptyline, worsen the metabolic profile, increasing insulin resistance, contributing to weight gain and causing hyperglycemia, thereby increasing the risk of diabetes with prolonged use [77]

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