Obesity Comorbidity With Major Depressive Disorder

The experts blog about psychiatry

Robert D. Levitan, MD

One of the greatest challenges in psychiatric and medical research is clinical heterogeneity. To address this complexity head-on, we must, wherever possible, refine the target phenotypes that we study and treat.

A good example of a phenotype in need of refinement can be found in the common and challenging problem of depression-obesity comorbidity. While over 120 articles have been published on this topic to date, almost all have considered depression as a unitary diagnosis, ignoring the fundamental importance of neurovegetative depressive subtypes that have primary relevance to weight gain. This lack of attention is highly problematic, given that one major subtype of MDD (atypical depression) is associated with increased appetite and overeating, while another (classic melancholia) is associated with decreased appetite and weight loss in most cases.

The main finding from our study, as hypothesized a priori, is that atypical depression is, in fact, associated with a much higher risk for obesity than is melancholia, which, in fact, has no increased risk for obesity relative to the population as a whole. These findings were not significantly influenced by gender, age, or whether depression was active in the past year.

This finding points to a need for significant refinement of study hypotheses and phenotyping for future work on depression-obesity comorbidity, which should, in turn, improve treatment options over time.

Robert D. Levitan, MD

University of Toronto, Toronto, Ontario, Canada


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