Is Weight Gain Typical in Atypical Depression?Friday, July 11, 2014
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
Friday, July 11, 2014
It is quite possible that atypical depression is often caused by obesity and not just associated with it. I am amazed as to how many of my obese patients have symptoms of atypical depression and also how frequently the depression resolves with significant weight loss and resolution of cardiometabolic risk factors. I also see depression resolving with treatment of sleep apnea and with improvements in diabetes. All related to reduced inflammation?
Here is a really important paper:
Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression. Molecular Psychiatry [Mol Psychiatry] 2013 Jun; Vol. 18 (6), pp. 692-9. Date of Electronic Publication: 2012 Oct 23.
Friday, July 11, 2014
This research is probably no surprise to many of us who suffer from atypical depression, as I have for over 40 years. Unfortunately, despite years of trying everything the medical community suggested, I’ve never found any treatment for the depression that worked for me for any length of time, so now I’m very obese and basically home bound. Once, when I had some relief, I only noticed it when I saw someone riding a bicycle and thought “that looks like fun” – whoa! I must be getting better. On other occasions, when it went from bad to not so bad, I noticed it because I felt like “my head was going faster than my body”. That is, I was able to hold my head up, be eager to do something and wanted to get on with it, but was held back by my body, rather than feeling that heaviness of spirit and body that comes with the depression.
Saturday, July 12, 2014
It is necessary to reach a balance between depression and weight gain. This is an interesting study for “atypical” depression. I truly believe that the right combination of routine exercise and a disciplined diet is important.