Managing comorbid obesity and depression through clinical pharmacotherapies

ABSTRACT

Introduction: Obesity and mood disorders co-occur more often than expected by chance alone. As no randomized, controlled pharmacotherapy trials have been conducted in obese patients with an active mood disorder, it is unclear how to use medication to treat this patient group.

Areas covered: We briefly overview the relationship between obesity and mood disorders; the effects of psychotropic medications commonly used in mood disorders on body weight; the psychiatric effects of available anti-obesity medications; and highlight the few treatment studies of medications in obese patients with mood disorders or depressive symptoms. As binge eating and psychotropic-induced weight gain are common correlates of obese patients with mood disorders, we also provide brief overviews of the pharmacotherapy of these conditions.

Expert opinion: When treating a patient with a mood disorder and obesity, both conditions need to be a focus of clinical attention. Psychotropic medications that have minimal weight gain effects should be used if possible. Weight-loss agents can probably be used in some mood disorder patients, but must be done so cautiously and with a full understanding of their potential psychiatric effects and interactions with psychotropic medications. Knowledge of the pharmacotherapy of binge eating and psychotropic-induced weight gain is also crucial.

KEYWORDS:

• Bipolar disorder
• depression
• obesity
• pharmacotherapy

Article highlights

• Obesity and mood disorders (both major depressive and bipolar disorders) co-occur more often than expected by chance alone.

• No randomized, double-blind, placebo-controlled pharmacotherapy trial has yet been conducted in patents with both obesity and an active mood disorder.

• Many psychotropic drugs used to treat mood disorder patients affect body weight while many available weight-loss drugs have psychiatric effects.

• Pharmacotherapy of the patient with obesity and a mood disorder should be informed by understanding of the weight effects of psychotropic drugs, the psychiatric effects of weight-loss drugs, and the evolving areas of pharmacotherapy of binge eating and psychotropic-induced weight gain.

• Obesity and mood disorders are chronic illnesses that each need to be addressed in patents that have both.

This box summarizes key points contained in the article.

Declaration of interest

S.L McElroy a consultant to or member of the scientific advisory boards of Bracket, F. Hoffmann-La Roche Ltd., MedAvante, Myriad, Naurex, Novo Nordisk, Shire, and Sunovion. She is a principal or co-investigator on studies sponsored by the Alkermes, Forest, Marriott Foundation, National Institute of Mental Health, Naurex, Orexigen Therapeutics, Inc., Shire, Sunovion, and Takeda Pharmaceutical Company Ltd. She is also an inventor on United States Patent No. 6,323,236 B2, Use of Sulfamate Derivatives for Treating Impulse Control Disorders, and along with the patent’s assignee, University of Cincinnati, Cincinnati, Ohio, has received payments from Johnson & Johnson, which has exclusive rights under the patent. A.I. Guerdjikova is a consultant to Bracket. P.E Keck, Jr. is presently or has been in the past year a principal or co-investigator on research studies sponsored by Cephalon, Marriott Foundation, National Institute of Mental Health (NIMH), and Shire. He has been reimbursed for consulting to Merck, Otsuka, ProPhase, Shire, and Supernus. He is a co-inventor on United States Patent No. 6,387,956: Shapira NA, Goldsmith TD, Keck, PE Jr. (University of Cincinnati) Methods of treating obsessive-compulsive spectrum disorder comprises the step of administering an effective amount of tramadol to an individual. Filed 25 March 1999; approved 14 May 2002. He has received no financial gain from this patent. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.