Abstract
OBJECTIVE: Weight gain during psychopharmacologic treatment has
considerable impact on the clinical management of depression, treatment
continuation, and risk for metabolic disorders. As no profound clinical
risk factors have been identified so far, the aim of our analyses was to
determine clinical risk factors associated with short-term weight
development in 2 large observational psychopharmacologic treatment
studies for major depression.
METHOD: Clinical variables at baseline (age, gender, depression
psychopathology, anthropometry, disease history, and disease entity)
were analyzed for association with percent change in body mass index
(BMI; normal range, 18.5 to 25 kg/m(2)) during 5 weeks of naturalistic
psychopharmacologic treatment in patients who had a depressive episode
as single depressive episode, in the course of recurrent unipolar
depression or bipolar disorder according to DSM-IV criteria. 703
patients participated in the Munich Antidepressant Response Signature
(MARS) project, an ongoing study since 2002, and 214 patients
participated in a study conducted at the University of Muenster from
2004 to 2006 in Germany.
RESULTS: Lower BMI, weight-increasing side effects of medication,
severity of depression, and psychotic symptoms could be identified as
clinical risk factors associated with elevated weight gain during the
initial treatment phase of 5 weeks in both studies. Based on these
results, a composite risk score for weight gain consisting of BMI ≤ 25
kg/m(2), Hamilton Depression Rating Scale (17-item) score > 20, presence
of psychotic symptoms, and administration of psychopharmacologic
medication with potential weight-gaining side effects was highly
discriminative for mean weight gain (F4,909 = 26.77, P = 5.14E-21)
during short-term psychopharmacologic treatment.
CONCLUSIONS: On the basis of our results, depressed patients with low to
normal BMI, severe depression, or psychotic symptoms should be
considered at higher risk for weight gain during acute antidepressant
treatment. We introduce a new risk score that might be considered in
psychopharmacologic decisions for the prevention of weight gain and
resulting metabolic disorders.
