Manish K Jha1, Shereen Wakhlu1, Neha Dronamraju1, Abu Minhajuddin2, Tracy L Greer1, Madhukar H Trivedi3. 1. Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, United States. 2. Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, United States. 3. Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, United States. Electronic address: madhukar.trivedi@utsouthwestern.edu.
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.
RCT Entities:
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 Iparticipants. 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.
Authors: Elaine M Boland; Jeffrey R Vittengl; Lee Anna Clark; Michael E Thase; Robin B Jarrett Journal: J Affect Disord Date: 2019-10-31 Impact factor: 4.839
Authors: Jennifer L Furman; Abigail Soyombo; Andrew H Czysz; Manish K Jha; Thomas J Carmody; Brittany L Mason; Philipp E Scherer; Madhukar H Trivedi Journal: Pers Med Psychiatry Date: 2018-06-21
Authors: Marzieh Majd; Joshua M Smyth; Nan Lv; Lan Xiao; Mark B Snowden; Elizabeth M Venditti; Leanne M Williams; Olusola A Ajilore; Trisha Suppes; Jun Ma Journal: J Affect Disord Date: 2020-11-17 Impact factor: 4.839
Authors: Brittany L Mason; Abu Minhajuddin; Andrew H Czysz; Manish K Jha; Bharathi S Gadad; Taryn L Mayes; Madhukar H Trivedi Journal: Transl Psychiatry Date: 2022-01-11 Impact factor: 6.222
Authors: Jeremiah B Joyce; Caroline W Grant; Duan Liu; Siamak MahmoudianDehkordi; Rima Kaddurah-Daouk; Michelle Skime; Joanna Biernacka; Mark A Frye; Taryn Mayes; Thomas Carmody; Paul E Croarkin; Liewei Wang; Richard Weinshilboum; William V Bobo; Madhukar H Trivedi; Arjun P Athreya Journal: Transl Psychiatry Date: 2021-10-07 Impact factor: 7.989
Authors: Marlene P Freeman; Rebecca S Hock; George I Papakostas; Heidi Judge; Cristina Cusin; Sanjay J Mathew; Gerard Sanacora; Dan V Iosifescu; Charles DeBattista; Madhukar H Trivedi; Maurizio Fava Journal: J Clin Psychopharmacol Date: 2020 May/Jun Impact factor: 3.118