Validating pre-treatment body mass index as moderator of antidepressant treatment outcomes: Findings from CO-MED trial

Manish K. Jha, Shereen Wakhlu, Neha Dronamraju, Abu Minhajuddin, Tracy L. Greer, Madhukar H. Trivedi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Currently, there are no valid clinical or biological markers to personalize the treatment of depression. Recent evidence suggests that body mass index (BMI) may guide the selection of antidepressant medications with different mechanisms of action. Methods: Combining Medications to Enhance Depression Outcomes (CO-MED) trial participants with BMI measurement (n = 662) were categorized as normal- or underweight (<25), overweight (25-<30), obese I (30-<35), and obese II+ (≥35). Logistic regression analysis with remission as the dependent variable and treatment arm-by-BMI category interaction as the primary independent variable was used to evaluate if BMI differentially predicted response to escitalopram (SSRI) monotherapy, bupropion-escitalopram combination, or venlafaxine-mirtazapine combination, after controlling for gender and baseline depression severity. Results: Remission rates among the three treatment arms differed on the basis of pre-treatment BMI (chi-square=12.80, degrees of freedom=6, p =.046). Normal- or under-weight participants were less likely to remit with the bupropion-SSRI combination (26.8%) than SSRI monotherapy (37.3%, number needed to treat or NNT = 9.5) or venlafaxine-mirtazapine combination (44.4%, NNT = 5.7). Conversely, obese II+ participants were more likely to remit with bupropion-SSRI (47.4%) than SSRI monotherapy (28.6%, NNT = 5.3) or venlafaxine-mirtazapine combination (37.7%, NNT = 10.3). Remission rates did not differ among overweight and obese I participants. Limitations: Secondary analysis, higher rates of obesity than the general population. Conclusions: Antidepressant selection in clinical practice can be personalized with BMI measurements. Bupropion-SSRI combination should be avoided in normal- or under-weight depressed outpatients as compared to SSRI monotherapy and venlafaxine-mirtazapine combination and preferred in those with BMI≥35.

Original languageEnglish (US)
Pages (from-to)34-37
Number of pages4
JournalJournal of Affective Disorders
Volume234
DOIs
StatePublished - Jul 1 2018

Fingerprint

Antidepressive Agents
Bupropion
Body Mass Index
Citalopram
Biomarkers
Weights and Measures
Numbers Needed To Treat
Thinness
Outpatients
Therapeutics
Obesity
Logistic Models
Regression Analysis
mirtazapine
Venlafaxine Hydrochloride
Population

Keywords

  • Antidepressant medications
  • Body mass index
  • Major depressive disorder
  • Moderator
  • Obesity
  • Treatment selection

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Validating pre-treatment body mass index as moderator of antidepressant treatment outcomes : Findings from CO-MED trial. / Jha, Manish K.; Wakhlu, Shereen; Dronamraju, Neha; Minhajuddin, Abu; Greer, Tracy L.; Trivedi, Madhukar H.

In: Journal of Affective Disorders, Vol. 234, 01.07.2018, p. 34-37.

Research output: Contribution to journalArticle

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abstract = "Background: Currently, there are no valid clinical or biological markers to personalize the treatment of depression. Recent evidence suggests that body mass index (BMI) may guide the selection of antidepressant medications with different mechanisms of action. Methods: Combining Medications to Enhance Depression Outcomes (CO-MED) trial participants with BMI measurement (n = 662) were categorized as normal- or underweight (<25), overweight (25-<30), obese I (30-<35), and obese II+ (≥35). Logistic regression analysis with remission as the dependent variable and treatment arm-by-BMI category interaction as the primary independent variable was used to evaluate if BMI differentially predicted response to escitalopram (SSRI) monotherapy, bupropion-escitalopram combination, or venlafaxine-mirtazapine combination, after controlling for gender and baseline depression severity. Results: Remission rates among the three treatment arms differed on the basis of pre-treatment BMI (chi-square=12.80, degrees of freedom=6, p =.046). Normal- or under-weight participants were less likely to remit with the bupropion-SSRI combination (26.8{\%}) than SSRI monotherapy (37.3{\%}, number needed to treat or NNT = 9.5) or venlafaxine-mirtazapine combination (44.4{\%}, NNT = 5.7). Conversely, obese II+ participants were more likely to remit with bupropion-SSRI (47.4{\%}) than SSRI monotherapy (28.6{\%}, NNT = 5.3) or venlafaxine-mirtazapine combination (37.7{\%}, NNT = 10.3). Remission rates did not differ among overweight and obese I participants. Limitations: Secondary analysis, higher rates of obesity than the general population. Conclusions: Antidepressant selection in clinical practice can be personalized with BMI measurements. Bupropion-SSRI combination should be avoided in normal- or under-weight depressed outpatients as compared to SSRI monotherapy and venlafaxine-mirtazapine combination and preferred in those with BMI≥35.",
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AU - Dronamraju, Neha

AU - Minhajuddin, Abu

AU - Greer, Tracy L.

AU - Trivedi, Madhukar H.

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N2 - Background: Currently, there are no valid clinical or biological markers to personalize the treatment of depression. Recent evidence suggests that body mass index (BMI) may guide the selection of antidepressant medications with different mechanisms of action. Methods: Combining Medications to Enhance Depression Outcomes (CO-MED) trial participants with BMI measurement (n = 662) were categorized as normal- or underweight (<25), overweight (25-<30), obese I (30-<35), and obese II+ (≥35). Logistic regression analysis with remission as the dependent variable and treatment arm-by-BMI category interaction as the primary independent variable was used to evaluate if BMI differentially predicted response to escitalopram (SSRI) monotherapy, bupropion-escitalopram combination, or venlafaxine-mirtazapine combination, after controlling for gender and baseline depression severity. Results: Remission rates among the three treatment arms differed on the basis of pre-treatment BMI (chi-square=12.80, degrees of freedom=6, p =.046). Normal- or under-weight participants were less likely to remit with the bupropion-SSRI combination (26.8%) than SSRI monotherapy (37.3%, number needed to treat or NNT = 9.5) or venlafaxine-mirtazapine combination (44.4%, NNT = 5.7). Conversely, obese II+ participants were more likely to remit with bupropion-SSRI (47.4%) than SSRI monotherapy (28.6%, NNT = 5.3) or venlafaxine-mirtazapine combination (37.7%, NNT = 10.3). Remission rates did not differ among overweight and obese I participants. Limitations: Secondary analysis, higher rates of obesity than the general population. Conclusions: Antidepressant selection in clinical practice can be personalized with BMI measurements. Bupropion-SSRI combination should be avoided in normal- or under-weight depressed outpatients as compared to SSRI monotherapy and venlafaxine-mirtazapine combination and preferred in those with BMI≥35.

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