Managing comorbid obesity and depression through clinical pharmacotherapies

Abstract

When treating a patient with a mood disorder and obesity, both conditions need to be a focus of clinical attention. Psychotropic medications that have minimal weight gain effects should be used if possible. Weight-loss agents can probably be used in some mood disorder patients, but must be done so cautiously and with a full understanding of their potential psychiatric effects and interactions with psychotropic medications. Knowledge of the pharmacotherapy of binge eating and psychotropic-induced weight gain is also crucial.

Psychiatric Aspects of Obesity: A Narrative Review of Pathophysiology and Psychopathology

“…There is evidence that obesity and affective disorders represent reciprocal risk factors [43][44][45][46][47]. This mutual association is so strong and wide-ranging that some authors have begun to write about a "metabolic-mood syndrome" [48].…”

“…BD makes obesity more difficult to treat and psychotropic drugs used in its management can induce further weight gain, in particular atypical antipsychotics (their combination with mood stabilizers seems to be the most deleterious in this regard) [46]. Among antipsychotics, those associated with the greatest weight increase are clozapine and olanzapine, while among mood-stabilizers valproic acid seems to be the most obesogenic, although lithium salts are also frequently associated with weight gain [47]. Moreover, BD is commonly accompanied by eating disorders, in particular BED, which leads to a more severe form of obesity, both in terms of BMI and management difficulties [21,35,60].…”

“…In general, psychiatric comorbidity seems to compound the clinical outcomes of obesity and to undermine long-term weight loss achievement [47]. Obesity, in turn, complicates the clinical course of BD: bipolar patients with obesity reportedly have a higher frequency of mood episodes, shorter euthymic periods and are more resistant to lithium-based therapy compared with patients without obesity [46,66,67].…”

Multidisciplinary obesity treatment: Ten considerations from a mental health perspective

“…Patients with obesity and affective or psychotic disorders have often achieved remission of their symptoms with second-generation antipsychotics and have gained weight as a side effect. In these cases, it is advisable to add other agents that contribute to neutralizing the negative metabolic impact (McElroy, Guerdjikova, Mori, & Keck, 2016). 8.…”