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Multicenter Study
. 2023 Aug 15:335:349-357.
doi: 10.1016/j.jad.2023.05.042. Epub 2023 May 16.

Body mass index and clinical outcomes in individuals with major depressive disorder: Findings from the GSRD European Multicenter Database

Christoph Kraus  1 , Alexander Kautzky  2 , Victoria Watzal  2 , Anna Gramser  2 , Bashkim Kadriu  3 , Zhi-De Deng  3 , Lucie Bartova  2 , Carlos A Zarate Jr  3 , Rupert Lanzenberger  2 , Daniel Souery  4 , Stuart Montgomery  5 , Julien Mendlewicz  6 , Joseph Zohar  7 , Giuseppe Fanelli  8 , Alessandro Serretti  9 , Siegfried Kasper  10
Affiliations
Multicenter Study

Body mass index and clinical outcomes in individuals with major depressive disorder: Findings from the GSRD European Multicenter Database

Christoph Kraus et al. J Affect Disord. .

Abstract

Background: Individuals with major depressive disorder (MDD) are at higher risk for obesity. In turn, weight gain is a predisposing factor for depression. Although clinical data are sparse, suicide risk also appears to be elevated in obese patients. This study used data from the European Group for the Study of Resistant Depression (GSRD) to investigate clinical outcomes associated with body mass index (BMI) in MDD.

Methods: Data were drawn from 892 participants with MDD over the age of 18 years (580 female, 50.5 ± 13.6 years). Response and resistance to antidepressant medication, depression rating scale scores, and further clinical and sociodemographic variables were compared using multiple logistic and linear regressions controlled for age, sex, and risk of weight gain due to psychopharmacotherapy.

Results: Of the 892 participants, 323 were categorized as treatment-responsive and 569 as treatment-resistant. Within this cohort, 278 (31.1 %) were overweight (BMI = 25-29.9 kg/m2) and 151 (16.9 %) were obese (BMI > 30 kg/m2). Elevated BMI was significantly associated with higher suicidality, longer duration of psychiatric hospitalizations over their lifetimes, earlier age of onset of MDD, and comorbidities. There was a trend-wise association of BMI with treatment resistance.

Limitations: Data were analyzed in a retrospective, cross-sectional design. BMI was used as an exclusive measure of overweight and obesity.

Conclusions: Participants with comorbid MDD and overweight/obesity were at risk for worse clinical outcomes, suggesting that weight gain should be closely monitored in individuals with MDD in daily clinical practice. Further studies are needed to explore the neurobiological mechanisms linking elevated BMI to impaired brain health.

Keywords: Cognition; Comorbidity; Insulin resistance; Major depression; Treatment-resistant depression.

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Conflict of interest statement

Declaration of competing interest Not related to this study, C. Kraus received honoraria by Janssen and LivaNova, as well as travel support by Roche Austria and AOP Orphan. B. Kadriu is now a full-time employee and shareholder of Jazz Pharmaceuticals. Within the last three years, L. Bartova has received travel grants and consultant/speaker honoraria from Alpine Market Research, Angelini, Biogen, Diagnosia, Dialectica, Janssen, Lundbeck, Medizin Medien Austria, Novartis, Schwabe and Universimed. C.A. Zarate, Jr. is listed as a co-inventor on a patent for the use of ketamine in major depression and suicidal ideation; as a co-inventor on a patent for the use of (2R,6R)-hydroxynorketamine, (S)-dehydronorketamine, and other stereoisomeric dehydroxylated and hydroxylated metabolites of (R,S)-ketamine metabolites in the treatment of depression and neuropathic pain; and as a co-inventor on a patent application for the use of (2R,6R)-hydroxynorketamine and (2S,6S)-hydroxynorketamine in the treatment of depression, anxiety, anhedonia, suicidal ideation, and post-traumatic stress disorders. He has assigned his patent rights to the U.S. government but will share a percentage of any royalties that may be received by the government. R. Lanzenberger received travel grants and/or conference speaker honoraria from Bruker BioSpin within the last three years and investigator-initiated research funding from Siemens Healthcare regarding clinical research using PET/MR. He is a shareholder of the start-up company BM Health GmbH since 2019. A. Serretti is or has been a consultant/speaker for Abbott, Abbvie, Angelini, AstraZeneca, Clinical Data, Boehringer, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Innovapharma, Italfarmaco, Janssen, Lundbeck, Naurex, Pfizer, Polifarma, Sanofi, Servier, and Taliaz. In the past 3 years S. Kasper has served as a consultant or on advisory boards for Angelini, Biogen, Esai, Janssen, IQVIA, Mylan, Recordati, Sage and Schwabe and has served on speakers bureaus for Angelini, Aspen Farmaceutica S.A., Biogen, Janssen, Recordati, Schwabe, Servier, and Sun Pharma. All other authors have no conflict of interest to declare, financial or otherwise.

Figures

Fig. 1.
Fig. 1.
A) Body mass index (BMI) distribution and number of individuals in each BMI category. Mean and median indicate BMI values of the overall sample. B) Boxplots of the BMI categories.
Fig. 2.
Fig. 2.
Retrospective Montgomery–Åsberg Depression Rating Scale (MADRS) sub-item scores by body mass index (BMI) groups (i.e., baseline BMI values). Numbers in the spider graph represent MADRS subitem scales from 0 to 6. BMI groups correspond to those in Fig. 1. *p < 0.05 uncorrected, **Bonferroni corrected p-values. +Trend-wise significance (p < 0.1).
Fig. 3.
Fig. 3.
Post-treatment Montgomery–Åsberg Depression Rating Scale (MADRS) sub-item scores by body mass index (BMI) groups (i.e., post-treatment BMI values). BMI groups correspond to those in Fig. 1. Numbers in the spider graph represent MADRS subitem scales from 0 to 6. Note differences from baseline values in the ‘lassitude’ and ‘suicidal thoughts’ items. *p < 0.05 uncorrected, **Bonferroni corrected p-values.
Fig. 4.
Fig. 4.
Sex differences in the baseline ‘suicidal ideation’ sub-item of the Montgomery–Åsberg Depression Rating Scale (MADRS) by body mass index (BMI) groups. The numbers next to the bars represent individuals in each category. The overall sex difference in suicidality was significant at baseline but not at the post-treatment MADRS.
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