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Body weight as a predictor of antidepressant efficacy in the GENDEP project

Rudolf Uher1, Ole Mors, Joanna Hauser

  • 1Institute of Psychiatry, King's College London, United Kingdom. rudolf.uher@iop.kcl.ac.uk

Journal of Affective Disorders
|March 10, 2009
PubMed
Abstract

Insights

Higher body mass index (BMI) and obesity are linked to poorer antidepressant response, particularly with nortriptyline. This suggests body weight is a crucial factor in selecting depression treatments.

Area of Science:

  • Psychiatry and Pharmacology
  • Metabolic and Endocrine Disorders

Background:

  • Overweight and obesity are increasingly recognized as potential factors influencing treatment outcomes in major depressive disorder.
  • Previous research suggests a link between body weight and response to antidepressant medications, but the specificity of this association requires further investigation.

Purpose of the Study:

  • To investigate the moderating role of body weight, including body mass index (BMI) and obesity, on antidepressant treatment response in major depression.
  • To determine if the effect of body weight on antidepressant response varies based on the antidepressant's mechanism of action, specific depressive symptoms, and gender.

Main Methods:

  • A cohort of 797 individuals with major depression were treated with either escitalopram or nortriptyline for 12 weeks.
  • Body weight, height, BMI, and obesity status (BMI > 30) were measured.
  • Mixed linear models were employed to analyze changes in depressive symptoms as a function of BMI and obesity.

Main Results:

  • Elevated BMI and obesity were associated with a poorer treatment response to nortriptyline but not to escitalopram.
  • The impact of body weight on treatment outcomes was primarily observed in the improvement of neurovegetative symptoms, such as sleep and appetite.
  • Gender moderated the relationship between body weight and symptom improvement; obese men showed reduced response to nortriptyline, while obese women had poorer responses to both antidepressants.

Conclusions:

  • Body weight is a significant factor to consider during the assessment and treatment selection for major depression.
  • The findings suggest that the choice of antidepressant may need to be tailored based on a patient's body weight and gender.
  • Further research is needed to confirm these findings, especially given the relative specificity due to the absence of a placebo group and detailed body fat distribution data.

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