Depression or major depressive disorder (MDD) is not only one of the most common psychiatric problems, it also comes in many flavours.
While melancholic or “typical” depression is characterized by a loss of pleasure in most or all activities (anhedonia), a failure of reactivity to pleasurable stimuli, psychomotor retardation and a strong sense of guilt, “atypical” depression is characterized by mood reactivity (paradoxical anhedonia), excessive sleep or sleepiness (hypersomnia), a sensation of heaviness in limbs, and significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection.
An important further distinction is that “typical” depression is commonly associated with loss of appetite and weight loss, whereas “atypical” depression typically involves increased appetite (comfort eating), often with significant weight gain.
Now a study by Aurélie Lasserre and colleagues from Switzerland, published in JAMA Psychiatry, looks at the risk for weight gain in patients with different forms of depression.
The prospective population-based cohort study, included 3054 randomly selected residents of the City of Lausanne (mean age, 49.7 years; 53.1% were women) with 5.5 years of follow-up.
Depression subtypes according to the DSM-IV, as well as sociodemographic characteristics, lifestyle (alcohol and tobacco use and physical activity), and medication, were elicited using the semistructured diagnostic interviews.
As expected, only participants with the “atypical” subtype of MDD at baseline had a higher increase in adiposity and were about 3.75 times more likely to have developed obesity during follow-up than participants without MDD.
This association remained robust even after adjustment for a wide range of confounders.
Thus, as the authors note,
“The atypical subtype of MDD is a strong predictor of obesity. This emphasizes the need to identify individuals with this subtype of MDD in both clinical and research settings. Therapeutic measures to diminish the consequences of increased appetite during depressive episodes with atypical features are advocated.“
Although we should be wary of those antidepressants that can cause weight gain, an early diagnosis and treatment of atypical depression may well prevent further weight gain and perhaps facilitate weight loss in patients with atypical depression.
Clearly, screening for “atypical” depression must be an essential part of obesity assessment and management.
Lasserre AM, Glaus J, Vandeleur CL, Marques-Vidal P, Vaucher J, Bastardot F, Waeber G, Vollenweider P, & Preisig M (2014). Depression With Atypical Features and Increase in Obesity, Body Mass Index, Waist Circumference, and Fat Mass: A Prospective, Population-Based Study. JAMA psychiatry PMID: 24898270