title: Effect of comedication of bupropion and other antidepressants on body mass index.
abstract: BACKGROUND
  Weight gain as an adverse effect of monotherapy of antidepressant has been well-studied. The effects of augmentation therapy involving multiple antidepressants, on weight changes needs to be adequately addressed.
  
  
  OBJECTIVE
  To study the co-medication effects of bupropion in combination with six individual antidepressants on body mass index (BMI) using EMR based data analysis.
  
  
  METHODS
  Allscripts data warehouse was used to identify patients on monotherapy of five selective serotonin reuptake inhibitor (SSRI) drugs, escitalopram, sertraline, citalopram, paroxetine, fluoxetine, one selective norepinephrine reuptake inhibitor (SNRI) duloxetine and the aminoketone, bupropion for at least 180 days. We also identified patients on co-medication of SSRI/SNRI drugs with bupropion. Six ANCOVA models were built to compare the short term effects on BMI, among monotherapy and co-medication groups. The patients' clinical conditions and demographics were included to account for confounding effects.
  
  
  RESULTS
  Monotherapy of all the SSRI/SNRI drugs showed significant weight increase, consistent with that of previous studies. The co-medication of bupropion and escitalopram showed a significantly higher increase in BMI than monotherapy (P = 0.0102). The increase in BMI in the other five co-medication groups was not significantly different from their respective monotherapy groups.
  
  
  CONCLUSIONS
  Our study reports an adverse weight gain on co-medication of escitalopram and bupropion, which warrants further validation studies. Considering co-medication effects of antidepressants on weight is important to design robust depression treatment plans.
authors.affiliation: Allscripts, Malvern, PA, USA.
authors.forename: Priyadarshini P
authors.initials: PP
authors.lastname: Ravindran
authors.affiliation: Allscripts, Malvern, PA, USA.
authors.forename: Wenzhao
authors.initials: W
authors.lastname: Zang
authors.affiliation: Allscripts, Malvern, PA, USA.
authors.forename: Swetha
authors.initials: S
authors.lastname: Renukunta
authors.affiliation: Allscripts, Malvern, PA, USA.
authors.forename: Rick
authors.initials: R
authors.lastname: Mansour
authors.affiliation: Director Medical Informatics Group, Allscripts, 101 Lindenwood Drive, Malvern, PA 19355, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Denduluri
keywords: BMI; EMR; antidepressants; bupropion; comedication