title: Clinical risk factors for weight gain during psychopharmacologic treatment of depression: results from 2 large German observational studies.
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.
  
  
  METHODS
  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.
authors.affiliation: Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 Munich, Germany stkloiber@mpipsykl.mpg.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kloiber
authors.forename: Katharina
authors.initials: K
authors.lastname: Domschke
authors.forename: Marcus
authors.initials: M
authors.lastname: Ising
authors.forename: Volker
authors.initials: V
authors.lastname: Arolt
authors.forename: Bernhard T
authors.initials: BT
authors.lastname: Baune
authors.forename: Florian
authors.initials: F
authors.lastname: Holsboer
authors.forename: Susanne
authors.initials: S
authors.lastname: Lucae
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015992:Body Mass Index; D003863:Depression / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015430:Weight Gain / Q000187:drug effects*
chemical_list: D000928:Antidepressive Agents