Depression With Atypical Features and Increase in Obesity, Body Mass Index, Waist Circumference, and Fat Mass

Abstract

and obesity are 2 prevalent disorders that have been repeatedly shown to be associated. However, the mechanisms and temporal sequence underlying this association are poorly understood.OBJECTIVE To determine whether the subtypes of major depressive disorder (MDD; melancholic, atypical, combined, or unspecified) are predictive of adiposity in terms of the incidence of obesity and changes in body mass index (calculated as weight in kilograms divided by height in meters squared), waist circumference, and fat mass. DESIGN, SETTING, AND PARTICIPANTS This prospective population-based cohort study, CoLaus (Cohorte Lausannoise)/PsyCoLaus (Psychiatric arm of the CoLaus Study), with 5.5 years of follow-up included 3054 randomly selected residents (mean age, 49.7 years; 53.1% were women) of the city of Lausanne, Switzerland (according to the civil register), aged 35 to 66 years in 2003, who accepted the physical and psychiatric baseline and physical follow-up evaluations.EXPOSURES Depression subtypes according to the DSM-IV. Diagnostic criteria at baseline and follow-up, as well as sociodemographic characteristics, lifestyle (alcohol and tobacco use and physical activity), and medication, were elicited using the semistructured Diagnostic Interview for Genetic Studies. MAIN OUTCOMES AND MEASURESChanges in body mass index, waist circumference, and fat mass during the follow-up period, in percentage of the baseline value, and the incidence of obesity during the follow-up period among nonobese participants at baseline. Weight, height, waist circumference, and body fat (bioimpedance) were measured at baseline and follow-up by trained field interviewers. RESULTSOnly participants with the atypical subtype of MDD at baseline revealed a higher increase in adiposity during follow-up than participants without MDD. The associations between this MDD subtype and body mass index (β = 3.19; 95% CI, 1.50-4.88), incidence of obesity (odds ratio, 3.75; 95% CI, 1.24-11.35), waist circumference in both sexes (β = 2.44; 95% CI, 0.21-4.66), and fat mass in men (β = 16.36; 95% CI, 4.81-27.92) remained significant after adjustments for a wide range of possible cofounding. CONCLUSIONS AND RELEVANCEThe atypical subtype of MDD is a strong predictor of obesity. This emphasizes the need to identify individuals with this subtype of MDD in both clinical and research settings. Therapeutic measures to diminish the consequences of increased appetite during depressive episodes with atypical features are advocated.

A weighty problem…

“…As people with melancholic subtype typically report decreased appetite, the authors suggest that the weight gain probably compensates for losses during the previous episode. 5 The authors note that their study supports previous suggestions that specific subtypes have 'different biological correlates and … differential pathways to cardiovascular risk', and stress the importance of subtyping depression in future research. They also advocate 'therapeutic measures to diminish the consequences of increased appetite during depressive episodes with atypical features'.…”

“…Approximately 10% of the depressed patients experienced combined (both atypical and melancholic) episodes, while 14% and 29% had atypical and melancholic depression, respectively. 5 Neither current nor remitted episodes of combined or 'unspecified' depression were significantly associated with obesity. People with atypical depression at baseline were 3.75-fold more likely to develop obesity during follow up than non-depressed controls, after adjusting for confounders.…”

“…The authors comment that the link 'is not simply attributable to the occurrence of atypical depressive symptoms in already obese individuals, but to a strong prospective association'. 5 In people with remitted atypical depression, an 88% increase in obesity risk did not reach statistical significance. However, people with remitted melancholic depression were 2.11-fold more likely to become obese.…”

“…People with the 'melancholic' subtype report, for example: worse depression in the morning; early morning waking; psychomotor retardation or agitation; reduced appetite; and excessive guilt. 5 To examine whether weight gain varies depending on the subtype of depression, Swiss researchers followed 3054 people (53.1% were women) aged 35-66 years (mean 49.7 years) for 5.5 years. Of these, 7.6% had major depression at enrolment.…”

“…4 However, compelling evidence now suggests that, rather than be coincidental comorbidities, obesity and depression show a 'strong prospective association'. 5 Nevertheless, the mechanisms underlying the link and the sequence (whether obesity causes depression, vice versa or both) are unclear. 5 However, recent studies throw new light on this intimate, but poorly understood, 5 relationship.…”