Antidepressants Could Address Depression and Obesity Behaviors

Freya Tyrer, BSc, MSc

Antidepressants could be beneficial in managing the symptoms of depression, while changing the behaviors of people who are also overweight or obese.

Freya Tyrer, BSc, MSc, Leicester Real World Evidence Unit at the Diabetes Research Center at University of Leicester, led a research team in identifying the age and gender-specific incidence of depression, as well as the dose-response between body mass index (BMI) and the risk of depression and antidepressant drug prescribing in adults who are overweight or obese.

In the retrospective study, the investigators examined electronic health records to identify adults who were either overweight or obese with incident depression, but no prior depression diagnosis in their records. Each patient was followed up with between 2000-2019.

The investigators identified a total of 519,513 patients and found the overall incidence of depression was 9.2 per 1000 person-years. The rate of depression was also higher in women and in 40-59 year old men with severe obesity.

When compared with individuals who were overweight, the hazard of depression increased with each BMI category: 1.13 (30‐34 kg/m²; 95% CI, 1.10‐1.16), 1.34 (35‐39 kg/m²; 95% CI,1.29‐1.40), 1.51 (40‐44 kg/m²; 95% CI, 1.41‐1.61), and 1.67 (45‐49 kg/m²; 95% CI, 1.48‐1.87), attenuating at BMI 50+ kg/m² (1.54; 95% CI, 2.91‐1.84).

Antidepressants were prescribed in 66.3% of the cases, but prescriptions for fluoxetine decreased over time (20.4% [2000]; 8.8% [2018]), while prescriptions for sertraline increased (4.3% [2000]; 38.9% [2018]).

“We recommend guidance on antidepressant drug prescribing and specific services for people with obesity and depression that address both symptoms and behaviors,” the authors wrote.

Multi-nutrient supplementation and food-related behavioral activation therapy may have no effect on the prevention of major depressive disorder (MDD) among overweight adults.

In a randomized clinical trial published in 2019 investigators examined the impact of 2 unique nutritional plans—multi-nutrient supplementation and food-related behavioral activation therapy—might have on obese or overweight adults in Europe.

Previous trials have shown that keeping a high-quality diet correlates with reduced future onset of depressive symptoms, yet the authors noted there was still an apparent lack of studies exploring the impact of dietary strategies in terms of preventing MDD.

Investigators took results from a group of 1025 adults with a body mass index (BMI) between 25 and 40 who exhibited elevated depressive symptoms and no MDD episodes in the past 6 months. The group, comprised of individuals from Germany, Spain, the UK, and the Netherlands, was 75% female, had a mean age of 46.5 years, and an average BMI of 31.4.

The group was divided into 4 categories to determine the efficacy of multi-nutrient supplementation and food-related behavioral activation therapy as a means to reduce MDD in overweight or obese individuals. Patients were given supplements or placebo in the form of 2 pills per day for the course of the year.

Food-related behavioral activation therapy consisted of 21 sessions, 15 of which were individual and the remaining 6 were group sessions. Just placebo was given to 257 participants, 256 were given placebos with therapy, 256 were given only supplements, and 256 received supplements and therapy.

At the conclusion of the 12-month period, 105 (10%) of the participants had experienced an MDD. More than half of that group had been receiving the supplement. There were 32 (12.5%) individuals that received the supplement and no therapy that experienced an MDD, while 22 (8.6%) participants who received therapy and the supplement experienced an MDD.

The study, “Incidence of Depression and First‐Line Antidepressant Therapy in People with Obesity and Depression in Primary Care,” was published online in Obesity.