Incidence of Depression and First-Line Antidepressant Therapy in People with Obesity and Depression in Primary Care.
journal contributionposted on 17.04.2020, 11:26 by Freya Tyrer, Francesco Zaccardi, Kamlesh Khunti, Richard Morriss
OBJECTIVE:The aim of this study was to describe the age- and gender-specific incidence of depression, the dose-response relationship between BMI and risk of depression (Cox proportional hazards), and antidepressant drug prescribing in adults with overweight or obesity. METHODS:A retrospective electronic health record study using the Clinical Practice Research Datalink was conducted to identify adults with overweight and obesity (≥ 18 years) with incident depression (no prior depression diagnosis in their records), followed up from 2000 to 2019. RESULTS:Among 519,513 adults, incidence of depression was 9.2 per 1,000 person-years and was higher in women and in 40- to 59-year-old men who had severe obesity. Compared with having overweight, the hazard of depression increased with each BMI category as follows: 1.13 (30-34 kg/m2 ; 95% CI: 1.10-1.16), 1.34 (35-39 kg/m2 ; 1.29-1.40), 1.51 (40-44 kg/m2 ; 1.41-1.61), and 1.67 (45-49 kg/m2 ; 1.48-1.87), attenuating at BMI 50+ kg/m2 (1.54; 2.91-1.84). Antidepressants were prescribed as first-line therapy in two-thirds (66.3%) of cases. Prescriptions for fluoxetine reduced over time (20.4% ; 8.8% ), and prescriptions for sertraline increased (4.3% ; 38.9% ). CONCLUSIONS:We recommend guidance on antidepressant drug prescribing and specific services for people with obesity and depression that address both symptoms and behaviors.