Body weight as a predictor of antidepressant efficacy in the GENDEP project.
BACKGROUND
Being overweight or obese may be associated with poor response to antidepressants. The present report explores the moderation of antidepressant response by body weight to establish the specificity to antidepressant mode of action, type of depressive symptoms and gender.


METHODS
Height and weight were measured in 797 men and women with major depression treated with escitalopram or nortriptyline for twelve weeks as part of the Genome Based Therapeutic Drugs for Depression (GENDEP) project. Body mass index (BMI) and obesity (BMI>30) were tested as predictors of change in depressive symptoms using mixed linear models.


RESULTS
Higher BMI and obesity predicted poor response to nortriptyline but did not significantly influence response to escitalopram. The moderation of response by body weight was due to differential improvement in neurovegetative symptoms, including sleep and appetite. The relationship between body weight and change in neurovegetative symptoms was moderated by gender with obese men responding less to nortriptyline and obese women having poorer response to both antidepressants.


CONCLUSIONS
As no placebo arm was included, the specificity of findings to antidepressants is relative. Lack of specific measures precluded accounting for differences in body fat distribution.


CONCLUSIONS
Body weight should be considered in the assessment of depression as it may inform the selection of antidepressant treatment.
Uher
Rudolf
R
Institute of Psychiatry, King's College London, United Kingdom. rudolf.uher@iop.kcl.ac.uk
Mors
Ole
O
Hauser
Joanna
J
Rietschel
Marcella
M
Maier
Wolfgang
W
Kozel
Dejan
D
Henigsberg
Neven
N
Souery
Daniel
D
Placentino
Anna
A
Perroud
Nader
N
Dernovsek
Moica Zvezdana
MZ
Strohmaier
Jana
J
Larsen
Erik Roj
ER
Zobel
Astrid
A
Leszczynska-Rodziewicz
Anna
A
Kalember
Petra
P
Pedrini
Laura
L
Linotte
Sylvie
S
Gunasinghe
Cerisse
C
Aitchison
Katherine J
KJ
McGuffin
Peter
P
Farmer
Anne
A
D000328:Adult; D000339:Affect / Q000187:drug effects; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001066:Appetite / Q000187:drug effects; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D015283:Citalopram / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000235:genetics / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D009765:Obesity / Q000503:physiopathology / Q000523:psychology; D050177:Overweight / Q000503:physiopathology / Q000523:psychology; D012890:Sleep / Q000187:drug effects; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D015283:Citalopram; D009661:Nortriptyline