Depression, Antidepressant Use Associated With BMI in Youths

Depression and antidepressant use may be independently associated with increasing BMI over time among youth, suggesting an important unintended consequence of health care to the obesity epidemic. 

Researchers reported at ObesityWeek 2016 on longitudinal associations between depression diagnoses, antidepressant use, and BMI in children as young as 8 years old and found that there is a strong and independent association.

Lisa Bailey-Davis, EdD, RD, of the Center for Health Research at the Geisinger Health System in Danville, Pennsylvania, and colleagues examined electronic health record (EHR) data from 105,163 children aged 8 to 18. The investigators evaluated depression diagnoses as ever vs never, cumulative number of encounters with diagnoses, and total duration of diagnoses. The researchers also evaluated antidepressants as months of use. For this investigation, they examined associations with diagnoses alone, antidepressants alone, and then together.

National data from Centers for Disease Control and Prevention (CDC) suggest that 3.1% of adolescents aged 12 to17 self-reported using an antidepressant from 2005 to 2010, according to Bailey-Davis. However, when she and her colleagues examined EHR orders they found that antidepressants are ordered more frequently. 

“Antidepressants were ordered for 7.2% of 13-year-olds and 16.6% of 18-year-olds in our population-representative data. Five or more cumulative months of antidepressant use was strongly associated with increased body mass index, particularly among older youths. At age 18 years, youth treated with 12 or more months of antidepressants were likely to be 2.1 kg heavier than youth without antidepressants,” Bailey-Davis told Endocrinology Advisor.

She said depression diagnosis, independent of antidepressants, was also associated with higher BMI. At age 12 years, youth with at least 1 depression diagnosis had a higher average BMI than youth without such diagnosis. Until now, no prior studies have evaluated depression diagnoses and cumulative antidepressant use in relation to longitudinal BMI trajectories in a large population sample.

In this current study, 6172 (5.9%) children had a diagnosis of depression and 10,628 (10.1%) children had received antidepressant treatment. The researchers found children receiving medical assistance (30.9%) were more likely to be treated with antidepressants at all ages. They discovered that depression diagnosis and antidepressant use were each independently and positively associated with BMI trajectories. In addition, these associations were stronger with longer durations of diagnosis and treatment. 

“There are complex pathways and feedback loops in the relationship between depression, antidepressants, eating and activity behaviors, and weight. Our study disentangled the relationship between the diagnosis, the treatment, and BMI, and calls for careful clinical monitoring for youth with depression and those using antidepressants, as both are associated with higher BMI. Future studies are needed to evaluate causal associations and effective prevention and treatment strategies for this vulnerable group,” said Bailey-Davis.

She and her team noted that depression during adolescence is more common in girls, and sex differences persist as children age. The latest studies suggest that antidepressant use has risen nearly 400% since 1988, and this has occurred at a time when obesity rates have doubled in the United States. Some antidepressants are associated with weight gain, especially in adults with different propensities by medication classes. Tricyclic antidepressants and monoamine oxidase inhibitors have been associated with weight gain. However, selective serotonin reuptake inhibitors (SSRIs) and bupropion have been associated with weight loss, according to the researchers. 

“SSRIs were most commonly ordered antidepressant. At age 18, children treated with SSRIs for 12 or more months were 2.53 kg heavier than those not treated with antidepressants,” said Bailey-Davis.

Reference

1. Bailey-Davis L, Glass T, Pollak J, et al. Longitudinal associations between depression diagnoses, antidepressant orders and body mass index in youth. Abstract T-OR-2042. Presented at: ObesityWeek 2016; October 31-November 4, 2016; New Orleans, LA.