Incidence of depression and first-line antidepressant therapy in people with obesity and depression in primary care

Abstract

Objective: The aim of this study was to describe the age- and gender-specific incidence of depression, the dose-response relationship between BMI and risk of depression (Cox proportional hazards), and antidepressant drug prescribing in adults with overweight or obesity. Methods: A retrospective electronic health record study using the Clinical Practice Research Datalink was conducted to identify adults with overweight and obesity (≥ 18 years) with incident depression (no prior depression diagnosis in their records), followed up from 2000 to 2019. Results: Among 519,513 adults, incidence of depression was 9.2 per 1,000 person-years and was higher in women and in 40- to 59-year-old men who had severe obesity. Compared with having overweight, the hazard of depression increased with each BMI category as follows: 1.13 (30-34 kg/m2; 95% CI: 1.10-1.16), 1.34 (35-39 kg/m2; 1.29-1.40), 1.51 (40-44 kg/m2; 1.41-1.61), and 1.67 (45-49 kg/m2; 1.48-1.87), attenuating at BMI 50+ kg/m2 (1.54; 2.91-1.84). Antidepressants were prescribed as first-line therapy in two-thirds (66.3%) of cases. Prescriptions for fluoxetine reduced over time (20.4% [2000]; 8.8% [2018]), and prescriptions for sertraline increased (4.3% [2000]; 38.9% [2018]). Conclusions: We recommend guidance on antidepressant drug prescribing and specific services for people with obesity and depression that address both symptoms and behaviors. © 2020 The Obesity Society