Depression increases the risk of obesity: Combination of Effexor and Wellbutrin may help

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Tuesday, September 14, 2004 7:59 am Email this article
Depression and obesity may be related according to a new paper by researchers from the University of Cincinnati College of Medicine in Cincinnati, Ohio. In the case of atypical depression, a combination of Effexor (venlafaxine) and Wellbutrin (bupropion) may be effective for improving mood and help to reduce appetite and weight gain associated with type of depression according to two professors of psychiatry from University of Cincinnati College of Medicine. Depression and manic-depression associated with being overweight

The best studies suggest that:

• children and adolescents with major depression are at an increased risk for developing overweight;
• patients with bipolar disorder (manic-depression) have elevated rates of overweight, obesity, and abdominal obesity; and
• obese people seeking weight-loss treatment have higher rates of depression and bipolar disorder than the general population.

Atypical depression and excess belly fat associated with being overweight

The best community studies suggest that:

• females with atypical depression are significantly more likely to be overweight than females with typical depression; (see below for definitions of atypical and typical depression)
• obesity is associated with major depression in females;
• abdominal obesity is associated with depression in males and females; but
• most people who are overweight or obese in the community do not have a mood disorder.

Conclusion: Depression and obesity may be related

“Although the overlap between mood disorders and obesity may be coincidental, it suggests the two conditions may be related,” the authors concluded.

Typical depression associated with weight loss and insomnia

Typical depression is the associated with weight loss and insomnia along with other features of depression such as fatigue, low mood, tearfulness, loss of sex drive, irritability, anxiety, feelings of guilt or helplessness, and loss of concentration or forgetfulness.

Atypical depression: Definition

Atypical depression is the most common form of depression, affecting approximately 16-23 percent of people with depression according to a paper by Nelson and McElroy (2003). This type of depression is more common in females than males.

The rates of atypical depression are higher among people with manic-depression according to Nelson and McElroy (2003).

People with atypical depression have higher rates of panic disorder, social phobia, bipolar disorder, and bulimia than people with typical depression according to Nelson and McElroy (2003).

Atypical depression symptoms: excessive sleep, overeating, sensitivity to rejection

Atypical depression is defined as the ability to feel better temporarily in response to a positive life event, plus any two of the following criteria: excessive sleep, increased appetite or weight gain, a feeling of heaviness in the limbs, and a longstanding sensitivity to interpersonal rejection that results in significant social or occupational impairment according to Nelson and McElroy (2003).

Atypical depression often starts at an earlier age

Atypical depression tends to occur at an earlier age than other forms of depression, often first appearing when a person is in their teens.

Atypical depression: MAO inhibitors work better than tricyclic antidepressants or SSRIs

Research has found that patients with atypical depression respond better to monoamine oxidase inhibitors (MAO Inhibitors) such as Nardil (phenelzine) than to tricyclic antidepressants such as Elavil (amitriptyline) or Tofranil (imipramine).

Atypical depression: MAO inhibitors roughly twice as effective as tricyclic antidepressants: 72% vs 44%

One study found that MAO inhibitors are roughly twice as effective for atypical depression as trycyclic antidepressants helping 72 percent of patients taking Nardil (phenelzine) compared to 44 percent taking Tofranil (imipramine).

However, doctors rarely use MAO inhibitors as first-line antidepressants because of side effects and potential dietary and drug interactions. Most MAO inhibitors can cause dangerously high blood pressure if taken with certain drugs or foods such as cheese and wine which contain the amino acid tyramine.

Although not as well studied, the research suggests that serotonin reuptake inhibitors such as Prozac (fluoxetine) may not be as effective as MAO inhibitors such as Nardil (phenelzine) for this type of depression.

Atypical depression: Behavioral therapy works as well as MAO inhibitors

The research also suggests that cognitive behavioral therapy works as well as any drug for this type of depression, helping roughly 60 percent of patients given either cognitive behavioral therapy or the MAO inhibitor Nardil (phenelzine).

Atypical depression: Combination of Effexor and Wellbutrin may improve depression and reduce appetite, but can cause overexcitment

“In our clinical experience, the combination of venlafaxine [Effexor] and bupropion [Wellbutrin] can be effective for both depression and excessive eating in these patients, many of whom also exhibit other atypical features,” Nelson and McElroy (2003) note. (Both doctors receive money from various drug companies for research and to give speeches. See disclosure below.)

“A possible explanation is that the combined pharmacologic effect of venlafaxine [Effexor] and bupropion [Wellbutrin] resembles that of the [MAO inhibitors] (increased synaptic availability of serotonin, norepinephrine, and dopamine) without many [MAO inhibitors’] side effects, such as weight gain.”

Atypical depression: Combination of Effexor and Wellbutrin can cause overexcitment

“We have, however, also observed treatment-emergent hypomania when using this drug combination,” Nelson and McElroy (2003) also note. (Hypomania is a mild form of mania. Symptoms include excitability, hyperactive and talkativeness, quick anger and irritability, and a decreased need for sleep.)

REFERENCE

McElroy S, Kotwal R, Malhotra S, Nelson E, Keck P, Nemeroff C. Are mood disorders and obesity related? a review for the mental health professional. J Clin Psychiatry. 2004 May, 65(5):634-51, quiz 730.

AUTHOR’S CONTACT INFORMATION

Susan McElroy
Psychopharmacology Research and Eating Disorders and
Obesity Research and Treatment Programs
University of Cincinnati College of Medicine
Cincinnati, Ohio 45267-0559, USA
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OTHER REFERENCES

Nelson EB, Mcelroy SL. Atypical depression: piecing together symptoms, treatmsnets. Current Psychiatry. 2003 Apr, 2(4), paper online.

DISCLOSURE

Dr. Nelson receives grant/research support from Eli Lilly & Co. and Wyeth Pharmaceuticals and is on the speakers bureau of Wyeth Pharmaceuticals.

Dr. McElroy is a consultant or scientific advisor to Abbott Laboratories, Bristol-Myers Squibb Co., Elan Corp., GlaxoSmithKline, Janssen Pharmaceutica, Eli Lilly & Co., Novartis Pharmaceuticals Corp., Ortho-McNeil Pharmaceutical, UCB Pharma, and Wyeth Pharmaceuticals. She receives research support from Forest Laboratories, GlaxoSmithKline, Elan Corp., Eli Lilly & Co., Merck & Co., Ortho-McNeil Pharmaceutical, Pfizer Inc., Sanofi-Synthelabo, and UCB Pharma.

Articles on the same subject can be found here:

• Depression

• Tofranil (imipramine)

• Wellbutrin (bupropion)