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Atypical major depressive disorder appears linked to obesity

Obesity seems to be associated with major depressive disorder with atypical features, according to recent study findings published in JAMA Psychiatry.

“The present study provides additional insight into the complex relationship between atypical depression and adiposity by demonstrating that the high comorbidity between this depression subtype and obesity is not simply attributable to the occurrence of atypical depressive symptoms in already obese individuals, but to a strong prospective association between the atypical [major depressive disorder] subtype and adiposity,” the researchers wrote.

Aurélie M. Lasserre, MD, of Lausanne University Hospital in Switzerland, and colleagues evaluated 3,054 adults aged 35 to 66 years to determine whether subtypes of major depressive disorder (MDD) — melancholic, atypical combined or unspecified — could predict obesity or changes in BMI. At least one remitted MDD was reported by 36.7% of participants and 7.6% had current MDD. Of those with MDD, unspecified episodes were the most common (48%), followed by melancholic episodes (29%), atypical episodes (14%), and atypical and melancholic episodes (10%). Seventy-five percent of participants reported taking selective serotonin or serotonin-norepinephrine reuptake inhibitors, whereas fewer than 10% reported taking a tricyclic or tetracyclic drug.

Aurélie Lasserre

At baseline, mean BMI was 24.6 in women and 26.2 in men. Higher BMI at baseline was seen among participants with current or remitted atypical MDD and the current combined MDD subtype compared with those who had never been depressed. Overall, BMI increased by 2.6% at follow-up. Compared with participants who had never been depressed, higher BMI increase was seen among participants with current atypical MDD, remitted atypical episodes or remitted melancholic episodes at baseline.

At baseline, 12.4% of participants met criteria for obesity, which increased to 15.5% during follow-up. A higher prevalence of obesity was found among participants with remitted atypical MDD compared with those who had never been depressed. At follow-up, odds of being obese increased among participants who were not obese at baseline but have current atypical MDD, as well as those with remitted melancholic MDD.

“However, these subjects did not reveal a higher BMI or a higher prevalence of obesity at the follow-up than never depressed subjects, as their low baseline measures aligned themselves to those of never depressed subjects across time,” the researchers wrote. “The weight gain of these subjects was likely to reflect the compensation of the weight loss that occurred during the previous depressive episode.”

Women with current or remitted atypical MDD had higher fat mass compared with those who had never been depressed. This was similar for men with remitted atypical MDD.

“For the clinician, the atypical subtype deserves particular attention because this subtype is a strong predictor of adiposity,” the researchers wrote. “Accordingly, the screening of atypical features and, in particular, increased appetite in individuals with depression is crucial. The prescription of appetite-stimulating medication should be avoided in these patients and dietary measures during depressive episodes with atypical features are advocated. Clinical studies need to determine to what degree the timely and appropriate treatment of depressive episodes with atypical features can prevent an increase of adiposity during and after such episodes and thereby reduce the long-term risk for CVD and other chronic diseases related to obesity.”

Aurélie M. Lasserre, MD, can be reached at aurelie.lasserre@unil.ch.

Disclosure: See the study for a full list of disclosures.