Melancholic features related to rimonabant

Obesity is currently considered a global epidemic and its prevention and treatment is a major public health concern, demanding treatment which may combine a sociocultural approach, lifestyle modification, nutritional, pharmacological or surgical strategies. Rimonabant, an endocannabinoid antagonist, has been proposed as an agent for an average weight loss of 4 kg. However, the development of anxiety and depressive symptoms can be major side effects.

A 27-year-old businessman, after using rimonabant (20 mg/day) for 1 month for weight loss, developed a major depressive episode with melancholic features, which remitted after the interruption of rimonabant.

To our knowledge, a major depressive episode with melancholic or atypical features specifier has not been described since the initiation of rimonabant pharmacological trials. The Hospital Anxiety and Depression Scale, used in the rimonabant trials, assesses several key points of depressive patients. However, it neglects the somatic symptoms that correspond to the additional criterion for both of the mentioned features as well as suicidal ideation. The severity of an episode could also be underestimated depending on the assessment tool or on the clinical interview.

There may be an underestimation of depressive melancholic and atypical side effects related to Rimonabant use, due to the lack of consistent assessment with the appropriate screening tools. Pharmacological strategies should be adjunctive for obesity treatment when there is a failure in the lifestyle and nutritional modification strategies. Moreover, deeper global sociocultural changes should be made in the treatment and control of the global obesity epidemic.