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BMI, sex may be key to personalizing antidepressant treatment

Recent findings suggested that obesity and sex may indicate likelihood of remission following antidepressant medication, suggesting their utility for personalizing antidepressant choice.

“We are in the midst of a paradigm shift in the field of psychiatry, to find specific clinical and biological signals that help clinicians and patients decide what is the best treatment,” study researcher Leanne Williams, PhD, of VA Palo Alto Health Care system and Stanford University School of Medicine, said in a press release.

To determine if obesity and sex were differential predictors of acute remission of symptoms after treatment with common antidepressants, researchers analyzed data for 659 participants who completed the iSPOT-D practical randomized controlled clinical trial. Study participants were randomly assigned to receive escitalopram, sertraline or venlafaxine extended-release for 8 weeks. They were then categorized as remitters or nonremitters.

According to WHO criteria, 42% of participants were normal weight, 28% were overweight and 31% were obese.

Logistic regression models indicated BMI was a differential predictor of remission according to antidepressant type.

Participants who were morbidly obese were more likely to remit, particularly on venlafaxine extended-release, compared with participants with normal weight.

This was due to a reduction in physical symptoms, including sleep disturbance, somatic anxiety and appetite.

The number needed to treat was six.

Females with higher BMI were more likely to remit than males with higher BMI, regardless of medication type.

This was associated with change in cognitive symptoms, including suicidal ideation, guilt and psychomotor changes.

“Although these findings require replication, they are ready for ‘prime time’ translation into clinical practice where there are currently no indicators and algorithms available for guiding treatment choice for patients with both depression and anxiety,” Erin Green, PhD, of VA Palo Alto Health Care system and Stanford University School of Medicine, said in the release. – by Amanda Oldt

Disclosure: Green reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.