title: Relationship between obesity and depression: characteristics and treatment outcomes with antidepressant medication.
abstract: OBJECTIVE
  Obesity and major depressive disorder often co-occur. However, differences between obese and normal-weight depressed patients and the moderating effect of obesity on antidepressant treatment outcome are not well studied.
  
  
  METHODS
  Adults (n = 662) with major depressive disorder in the Combining Medications to Enhance Depression Outcomes study were randomized to treatment with escitalopram plus placebo, bupropion plus escitalopram, or venlafaxine plus mirtazapine for a 12-week primary treatment phase and 16-week follow-up. Body mass index (BMI) was calculated at baseline and categorized according to World Health Organization criteria: normal or low weight (NW), overweight, Obese I and Obese II+. A repeated-effects model, unadjusted and adjusted for baseline variables, assessed outcomes.
  
  
  RESULTS
  Obesity was common (46.2%), only 25.5% were NW. Higher BMI was associated with greater medical illness (p < .001), social phobia (p = .003), and bulimia (p = .026). Lower BMI was associated with more frequent post-traumatic stress disorder (p = .002) and drug abuse (p < .001). Treatment outcomes did not differ including Week 12 remission rates (NW 36%, overweight 40%, Obese I 43%, Obese II+ 37%; p = .69). Lower BMI was associated with more frequent (p = .024 [unadjusted] and .053 [adjusted]) and more severe (p = .008 [unadjusted] and .053 [adjusted]) adverse effects.
  
  
  CONCLUSIONS
  BMI was related to clinical presentation and prevalence of comorbidities, but not antidepressant outcomes. Lower BMI classes had more psychiatric comorbidities, potentially obscuring the relationship between BMI and antidepressant effects. Trial Registration ClinicalTrials.gov identifier: NCT00590863.
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119. madhukar.trivedi@utsouthwestern.edu.
authors.forename: Marisa S P
authors.initials: MS
authors.lastname: Toups
authors.forename: Alyson K
authors.initials: AK
authors.lastname: Myers
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Benji
authors.initials: B
authors.lastname: Kurian
authors.forename: David W
authors.initials: DW
authors.lastname: Morris
authors.forename: Augustus John
authors.initials: AJ
authors.lastname: Rush
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy / Q000453:epidemiology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009765:Obesity / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D012307:Risk Factors; D016037:Single-Blind Method; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: depression; obesity; treatment resistance