A patient’s body mass index (BMI) may play a role in the effectiveness of treatment with certain antidepressants for major depressive disorder, suggests a study published Thursday in the Journal of Affective Disorders.
Le Xiao, M.D., Ph.D., of Capital Medical University in Beijing and colleagues analyzed data collected in a clinical trial that included 202 adults with major depressive disorder at five hospitals from 2011 to 2016. Patients were 18 to 60 years and had scores of at least 20 on the 17-item Hamilton Rating Scale for Depression (HAMD-17) upon enrollment. All patients initially received paroxetine, and those whose symptoms did not begin to improve after two weeks were randomized to continue paroxetine, switch to mirtazapine, or take both paroxetine with mirtazapine for six weeks. BMI analysis revealed that 55% of patients had normal body weight, 35.1% were overweight or obese, and 9.9% were underweight.
The researchers found that patients who were normal weight or underweight were twice as likely to experience remission of their depression by the end of the eighth week, as defined by HAMD-17 scores of 7 or lower.
The researchers noted that one possible reason why people with a high BMI or excessive body fat may have a lower response to antidepressants compared with people with a lower BMI is that the drug must travel through more tissue and fluid in their bodies than in the bodies of people who are normal weight or underweight.
“The other potential mechanisms underlying the association between body weight and antidepressant response could be attributed to brain insulin resistance, inflammatory dysregulation, oxidative and nitrosative stress which is caused by obesity,” the researchers wrote. “Finally, decreased physical activity and obesity stigma can also contribute to poor response to antidepressants in patients with excess weight.”
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