Tuesday, November 24, 2020

Effects of Sertraline-Olanzapine on Weight, Cholesterol May Differ According to Patient Age

Older adults with psychotic depression may experience less weight gain and increases in total cholesterol than younger adults when taking a combination of sertraline and olanzapine over an extended period, suggests a study in the American Journal of Geriatric Psychiatry.

The findings are from the Study Pharmacotherapy of Psychotic Depression II (STOP-PD II). The original STOP-PD trial established that a combination therapy of the antidepressant sertraline plus the antipsychotic olanzapine was more likely to lead to remission of psychotic depression than olanzapine alone over 12 weeks of therapy. STOP-PD II examined the risks and benefits of patients continuing to take sertraline and olanzapine to prevent a relapse of the symptoms. (Eli Lilly provided olanzapine and matching placebo pills and Pfizer provided sertraline; neither company provided funding for this study.)

“Older adults are more likely to experience psychotic features during a major depressive episode than younger adults,” wrote Alastair J. Flint, M.B., of the Department of Psychiatry at the University of Toronto and colleagues. Metabolic disorders, such as diabetes and hyperlipidemia, also increase later in life. “It is therefore important to determine whether there are age-related differences in anthropometric and metabolic outcomes associated with the treatment of psychotic depression with antipsychotic medication,” Flint and colleagues wrote.

They analyzed data from 269 adults aged 18 to 85 years with psychotic depression who were treated with open-label sertraline plus olanzapine for up to 12 weeks (acute phase). A total of 126 participants who remained in remission for eight weeks (stabilization phase) on the sertraline-olanzapine combination were then randomly divided into two groups: one group continued taking the sertraline-olanzapine combination, and the other group was transitioned to a sertraline-placebo combination; the randomized phase was for 36 weeks. The researchers evaluated changes in participants’ weight, waist circumference, plasma lipids, glucose, hemoglobin A1c, and insulin over the course of the study, comparing participants aged 18 to 59 (younger) with those 60 to 85 (older).

While both younger and older participants experienced weight gain and an increase in total cholesterol levels when treated with sertraline-olanzapine versus sertraline-placebo, “the increase in these measures was less in the older group,” Flint and colleagues reported.

“At the acute-stabilization termination visit, mean weight in older participants remained below their mean premorbid weight, whereas it was approximately 18 lb. higher than premorbid weight in younger participants,” they continued. “These findings suggest that the weight gained during the acute and stabilization treatment of psychotic depression was partial restoration of lost weight in older patients [during depressive episodes] but clinically significant excess weight in younger patients.” There were no clinically significant differences between younger and older participants in glycemic measures.

For related information, see the Psychiatric News article “Maintenance Antipsychotic Lowers Risk of Psychotic Depression Relapse.”

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