Article
Prescribing antidepressants in general practice: can obesogenic adverse effects be associated with worse health outcomes in patients with depression and excess weight?
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Published: | September 15, 2022 |
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Outline
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Hintergrund: The majority of antidepressants (AD) are prescribed by general practitioners. Patients with excess weight may have a poor response to AD and may be more vulnerable to negative consequences of weight-increasing (obesogenic) adverse effects. It is important to evaluate the need to implement a differential approach to AD selection for patients with excess weight.
Fragestellung: To estimate the difference in risk for all-cause hospitalizations between people with and without excess weight who were prescribed obesogenic AD.
Fragestellung/Diskussionspunkt: The cohort of incident users of AD, with depression diagnosed and weight status measured before the first AD prescription, was extracted from the population-based cohort “TorSaDE” (Quebec, Canada). The role of excess weight in the association between exposure to obesogenic AD and all-cause hospitalizations during the 12 months of treatment was examined. Cox regression analysis, with a time-varying exposure to obesogenic AD (versus non-obesogenic AD) and time-fixed weight status was applied.
Methoden: The cohort of incident users of AD, with depression diagnosed and weight status measured before the first AD prescription, was extracted from the population-based cohort “TorSaDE” (Quebec, Canada). The role of excess weight in the association between exposure to obesogenic AD and all-cause hospitalizations during the 12 months of treatment was examined. Cox regression analysis, with a time-varying exposure to obesogenic AD (versus non-obesogenic AD) and time-fixed weight status was applied.
Ergebnisse: Of the 1,453 participants, 66.3% were women, the mean age was 53.8 years (standard deviation (SD)=18.7), and 738 (50.8%) had excess weight. The hazard ratio for hospitalizations, adjusted for age, sex, income, level of education, comorbidities, and past health service use (aHR) was 1.84 (95%CI: 1.16, 2.90) in patients jointly exposed to excess weight and obesogenic AD compared to the jointly unexposed group; aHR was 1.50 (95%CI: 0.96, 2.34) and 1.79 (95%CI: 0.87, 3.68) compared to patients with only excess weight or only on obesogenic AD, respectively.
Diskussion: The trend for increased risk of hospitalizations in patients jointly exposed to excess weight and obesogenic AD suggests synergic (super-additive) interactions. Patients with excess weight may benefit less from treatment with obesogenic AD than patients without excess weight.
Take Home Message für die Praxis: When treating patients for depression, special attention should be paid to the patient’s weight status in the selection of antidepressants