Influence of body mass index on the choice of therapy for depression and follow-up care§

Authors


  • The authors of this article are responsible for its content. No statement may be construed as the official position of the NIMH. The funder had no role in the conduct of the study; collection, management, analysis, and interpretation of the data; or preparation and approval of the manuscript.

  • Author Contributions: Study concept and design: D. Arterburn, A. Bogart, D. M. Boudreau, S. Haneuse, and G. Simon; Acquisition of data: D. Arterburn, A. Bogart, D. M. Boudreau, M. K. Theis, and E. Westbrook; Analysis and interpretation of data: D. Arterburn, A. Bogart, D. M. Boudreau, and S. Haneuse; Drafting of the manuscript: D. Arterburn, A. Bogart, and D. M. Boudreau; Critical revision of the manuscript for important intellectual content: D. Arterburn, A. Bogart, D. M. Boudreau, S. Haneuse, G. Simon, and E. Westbrook; Statistical analysis: A. Bogart and S. Haneuse; Obtaining funding: D. Arterburn, D. M. Boudreau, S. Haneuse, and G. Simon; Administrative, technical, or material support: D. Arterburn, M. K. Theis, and E. Westbrook; Study supervision: D. Arterburn and E. Westbrook.

  • §

    Disclosure: The authors declared no conflict of interest.

  • Funding agencies: This research was supported by grant (R01 MH083671) from the National Institute of Mental Health (NIMH).

Abstract

Objective: Overweight and obese patients commonly suffer from depression and choice of depression therapy may alter weight. We conducted a cohort study to investigate whether obesity is associated with treatment choices for depression; and whether obesity is associated with appropriate duration of depression treatment and receipt of follow-up visits.

Design and Methods: Adults with a diagnosis of depression between January 1, 2006 and March 31, 2010 who had 1+ new episodes of an antidepressant medication and/or psychotherapy were eligible. Medication use, encounters, diagnoses, height, and weight were collected from health plan databases. We modeled receipt of the different therapies (medication and psychotherapy) by BMI and BMI trajectory during the 9-months prior to initiation of therapy using logistic regression models that accommodated correlation within provider and adjusted for covariates. We modeled BMI via a restricted cubic spline. Fluoxetine was the reference treatment option in the medication models.

Results: Lower BMI was associated with greater use of mirtazapine, and a declining BMI prior to treatment was associated with greater odds of initiating mirtazapine and paroxetine. Higher BMI was associated with greater odds of initiating bupropion even after adjustment for smoking status. Obese patients were less likely to receive psychotherapy and less likely to receive appropriate duration (180-days) of depression treatment compared to normal weight subjects.

Conclusions: Our study provides evidence that BMI is considered when choosing therapy but associations were weak. Our results should prompt discussion about recommending and choosing depression treatment plans that optimize depression care and weight management concurrently. Differences in care and follow-up by BMI warrant additional research.

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