Changes in Symptoms of Depression With Weight Loss: Results of a Randomized Trial

Department of Psychiatry, Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Obesity (Impact Factor: 3.73). 02/2009; 17(5):1009-16. DOI: 10.1038/oby.2008.647
Source: PubMed


Recent studies of rimonabant have re-awakened interest in the possible adverse psychiatric effects of weight loss, as well as of weight loss medications. This study examined changes in symptoms of depression in 194 obese participants (age = 43.7 +/- 10.2 years; BMI = 37.6 +/- 4.1 kg/m(2)) in a 1-year randomized trial of lifestyle modification and medication. Participants were assigned to (i) sibutramine alone; (ii) lifestyle modification alone; (iii) sibutramine plus lifestyle modification (i.e., combined therapy); or (iv) sibutramine plus brief therapy. Participants completed the Beck Depression Inventory-II (BDI-II) at baseline and weeks 6, 10, 18, 26, 40, and 52. At 1 year, participants in combined therapy lost the most weight and those in sibutramine alone the least (12.1 +/- 8.8% vs. 5.5 +/- 6.5%; P < 0.01). Mean BDI-II scores across all participants declined from 8.1 +/- 6.9 to 6.2 +/- 7.7 at 1 year (P < 0.001), with no significant differences among groups. Despite this favorable change, 13.9% of participants (across the four groups) reported potentially discernible increases (>or= 5 points on the BDI-II) in symptoms of depression at week 52. They lost significantly less weight than participants in the rest of the sample (5.4 +/- 7.8% vs. 9.0 +/- 7.8%, respectively; P < 0.03). The baseline prevalence of suicidal ideation was 3.6%. Seven new cases of suicidal ideation were observed during the year, with three in lifestyle modification alone. Further research is needed to identify characteristics of obese patients at risk of negative mood changes (and suicidal ideation) in response to behavioral and pharmacologic therapies.

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    • "• Relationships among obesity and depression (Simon et al., 2010; Rubin et al., 2010); important questions whether weight loss may aggravate or reduce depression (Faulconbridge et al., 2009). • Healthy coping skills for stress management may mediate relationships of stress with both depression and diabetes. "

    Full-text · Dataset · Oct 2013
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    • "A recent study suggested a possible explanation for these contradictory findings. Faulconbridge et al.51) followed a cohort of 194 obese subjects that were randomized into four groups: i) sibutramine alone, ii) lifestyle modification alone, iii) sibutramine and lifestyle modification, and iv) sibutramine and brief therapy. The trial duration was one year and depressive symptoms were assessed using the Beck Depression Inventory (BDI)-II. "
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    ABSTRACT: A safe and effective way to control weight in patients with affective disorders is needed, and phentermine is a possible candidate. We performed a PubMed search of articles pertaining to phentermine, sibutramine, and affective disorders. We compared the studies of phentermine with those of sibutramine. The search yielded a small number of reports. Reports concerning phentermine and affective disorders reported that i) its potency in the central nervous system may be comparatively low, and ii) it may induce depression in some patients. We were unable to find more studies on the subject; thus, it is unclear presently whether phentermine use is safe in affective disorder patients. Reports regarding the association of sibutramine and affective disorders were slightly more abundant. A recent study that suggested that sibutramine may have deleterious effects in patients with a psychiatric history may provide a clue for future phentermine research. Three explanations are possible concerning the association between phentermine and affective disorders: i) phentermine, like sibutramine, may have a depression-inducing effect that affects a specific subgroup of patients, ii) phentermine may have a dose-dependent depression-inducing effect, or iii) phentermine may simply not be associated with depression. Large-scale studies with affective disorder patients focusing on these questions are needed to clarify this matter before investigation of its efficacy may be carried out and it can be used in patients with affective disorders.
    Full-text · Article · Apr 2013 · Clinical Psychopharmacology and Neuroscience
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    • "• Relationships among obesity and depression (Simon et al., 2010; Rubin et al., 2010); important questions whether weight loss may aggravate or reduce depression (Faulconbridge et al., 2009). • Healthy coping skills for stress management may mediate relationships of stress with both depression and diabetes. "
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    ABSTRACT: Considering the relationships between diabetes and depression may enhance programs to reduce their individual and shared disease burden. This paper discusses relationships between diabetes and depression, the range of influences on each, conceptual issues central to their definition, and interventions including comprehensive, population approaches to their prevention and management. Foundational and exemplary literature was identified by the writing team according to their areas of expertise. Diabetes and depression influence each other while sharing a broad range of biological, psychological, socioeconomic and cultural determinants. They may be viewed as: (a) distinct but sometimes comorbid entities, (b) dimensions, (c) parts of broader categories, e.g., metabolic/cardiovascular abnormalities or negative emotions, or (d) integrated so that comprehensive treatment of diabetes includes depression or negative emotions, and that of depression routinely considers possible diabetes or other chronic diseases. The choice of literature relied primarily on the authors' knowledge of the issues addressed. Some important perspectives and research may have been overlooked. Collaboration among primary care and specialist clinicians as well as program and public health managers should reflect the commonalities among diabetes, depression, and other chronic mental and physical disorders. Interventions should include integrated clinical care and self-management programs along with population approaches to prevention and management. Self management and problem solving may provide a coherent framework for integrating the diverse tasks and objectives of those living with diabetes and depression or many other varieties of multi-morbidity.
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