Association of treatment response with obesity and other metabolic risk factors in adults with depressive disorders: Results from a National Depression Cohort study in Korea (the CRESCEND study).

Abstract

Background: Availablestudiesindicatethatobesitymayexertamoderationaleffectonantidepressant treatment response.Theaimofthisstudywastoinvestigatetherelationshipbetweentreatmentre- sponse andmetabolicabnormalitiesamongstpatientswithdepressivedisordersinalargenaturalistic clinical setting. Methods: A nationwideprospectivestudywasconductedin18hospitalsinSouthKorea;541depressive patients meetingDSM-IVcriteriawererecruited.Afterbaselineevaluation,subjectsreceivednaturalistic clinician-determined antidepressantinterventions.Assessmentwasperformedatbaselineandweeks1, 2, 4,8,12,24and52.Treatmentresponsewasdefined asa Z50% reductionfrombaselineonatleastone evaluationpoint. Results: In univariatecomparison,thepatientswhoshowedinsufficient responsetoantidepressant therapyweremorelikelytobemale,unmarried,unemployed,andobese.Afteradjustingforbaseline variables,malesex(OR¼1.82)andobesity(OR¼1.55)remainedasweresignificant variables.Stratification ofthesubjectsintooneofthreegroups,i.e.male,pre-menopausalfemaleandpost-menopausal female, revealedthatmaleswithconcurrentmetabolicproblems,(i.e.thepresenceofoneormoreof hypertension,hyperglycemia,orhypercholesterolemia)hadsignificantly higherriskforinsufficient re- sponse (OR¼2.32) and,afteradjustingforbaselinevariables,obesitypredictedinsufficient responsein post-menopausal female(OR¼2.41). Conclusions: The presenceofmetabolicabnormalitiesinpatientswithdepressivedisorderswasasso- ciated withdecreasedtreatmentresponsetoantidepressants.Theseresultsunderscoretheneurobio- logical relationshipbetweenobesityandthecentralnervoussystem,andprovideempiricevidence supporting stratification oftreatmentresponseindepression.