title: Influence of body mass index on the choice of therapy for depression and follow-up care.
abstract: OBJECTIVE
  Overweight and obese patients commonly suffer from depression and choice of depression therapy may alter weight. We conducted a cohort study to investigate whether obesity is associated with treatment choices for depression; and whether obesity is associated with appropriate duration of depression treatment and receipt of follow-up visits.
  
  
  METHODS
  Adults with a diagnosis of depression between January 1, 2006 and March 31, 2010 who had 1+ new episodes of an antidepressant medication and/or psychotherapy were eligible. Medication use, encounters, diagnoses, height, and weight were collected from health plan databases. We modeled receipt of the different therapies (medication and psychotherapy) by BMI and BMI trajectory during the 9-months prior to initiation of therapy using logistic regression models that accommodated correlation within provider and adjusted for covariates. We modeled BMI via a restricted cubic spline. Fluoxetine was the reference treatment option in the medication models.
  
  
  RESULTS
  Lower BMI was associated with greater use of mirtazapine, and a declining BMI prior to treatment was associated with greater odds of initiating mirtazapine and paroxetine. Higher BMI was associated with greater odds of initiating bupropion even after adjustment for smoking status. Obese patients were less likely to receive psychotherapy and less likely to receive appropriate duration (180-days) of depression treatment compared to normal weight subjects.
  
  
  CONCLUSIONS
  Our study provides evidence that BMI is considered when choosing therapy but associations were weak. Our results should prompt discussion about recommending and choosing depression treatment plans that optimize depression care and weight management concurrently. Differences in care and follow-up by BMI warrant additional research.
authors: Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA. boudreau.d@ghc.org
authors: Denise M
authors: DM
authors: Boudreau
authors: David
authors: D
authors: Arterburn
authors: Andy
authors: A
authors: Bogart
authors: Sebastien
authors: S
authors: Haneuse
authors: Mary Kay
authors: MK
authors: Theis
authors: Emily
authors: E
authors: Westbrook
authors: Greg
authors: G
authors: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D015992:Body Mass Index; D002755:Choice Behavior; D015331:Cohort Studies; D003863:Depression / Q000628:therapy*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D009765:Obesity / Q000628:therapy; D017374:Paroxetine / Q000627:therapeutic use; D011613:Psychotherapy / Q000379:methods; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D005473:Fluoxetine; D008803:Mianserin; D017374:Paroxetine; D000078785:Mirtazapine
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