Antidepressant Treatment and Risk of Obesity

描述(由申请人提供)：肥胖和抑郁是主要的公共卫生问题，对医疗发病率、医疗保健支出和生活质量有重大影响。2002年，美国成年人的肥胖率(定义为体重指数[BMI，计算为体重(公斤)除以身高(米)的平方])为31%，DSM-IV主要抑郁障碍的终生患病率为13%。肥胖和抑郁并存的情况也很常见，同时患有这两种疾病的成年人可能会有更大的健康风险。值得注意的是，肥胖的风险可能会受到抗抑郁药物治疗选择的严重影响。鉴于抗抑郁药物现在是美国最常用的处方药，抗抑郁药物治疗对体重增加风险的潜在影响是公共卫生和临床实践中的一个紧迫问题。从1988年到2002年，抗抑郁药物的使用率增加了两倍多，从2.5%上升到8.1%；在同一时间段，肥胖症的流行率从23%上升到31%。这些重叠的长期趋势促使一些研究人员提出，医药学是肥胖症流行的一个重要因素。我们建议的研究的主要目标是检查抑郁症治疗的选择之间的关系，包括药物治疗和心理治疗，以及在人群水平上体重增加的长期风险。进行一项前瞻性随机试验来解决这一目标的成本将高得令人望而却步。因此，我们提出了一项从2005年到2009年在综合健康计划和护理提供系统中对超过50,000名新诊断为抑郁症的人进行的回顾性观察研究。这项研究将利用我们的医疗保健系统提供全面的患者护理，以及复杂的电子数据系统，这些系统可以有效地识别患有抑郁症和肥胖症的大量人群，以及评估体重、健康状况和医疗保健使用的长期变化。我们的具体目标将描述新诊断为抑郁症的成年人体重变化的自然历史，检查肥胖与新诊断为抑郁症的成年人中抑郁护理过程之间的关联，并评估在一组新的抗抑郁药使用者中不同抗抑郁药的体重变化轨迹的差异。这些分析将整合精神病学、药物流行病学、初级保健、生物统计学和卫生服务研究的学科，以全面解决肥胖和抑郁症护理之间的关系。该项目将利用卫生保健提供系统的新用途来调查体重增加的流行病学，这可能对初级和专科环境中的抑郁症治疗以及未来的肥胖症流行病学研究具有广泛的影响。公共卫生相关性：肥胖和抑郁是主要的公共卫生问题，对医疗发病率、医疗保健支出和生活质量有重大影响。该项目将使用来自综合健康计划和医疗保健提供系统的数据来调查长期体重增加风险与成年抑郁症患者选择抗抑郁药物治疗有关的假设。我们的具体目标将整合精神病学、药物流行病学、初级保健、生物统计学和卫生服务研究的学科，以全面解决肥胖和抑郁症护理之间的关系。

DESCRIPTION (provided by applicant): Obesity and depression are major public health concerns that have substantial impacts on medical morbidity, health care expenditures, and quality of life. In 2002, the prevalence of obesity (defined as a body mass index [BMI, calculated as weight in kilograms divided by the square of height in meters] of e 30) among US adults was 31% and the lifetime prevalence of DSM-IV major depressive disorder was 13%. The co-occurrence of obesity and depression is also common and adults with both conditions may have even greater health risks. Notably, the risk of obesity may be heavily influenced by the choice of antidepressant drug therapy. The potential impact of antidepressant treatment on the risk of weight gain is a pressing issue for public health and clinical practice given that antidepressant agents are now the most commonly prescribed drugs in the United States. Between 1988 and 2002, the prevalence of antidepressant use more than tripled, from 2.5% to 8.1%; and, over the same time frame, the prevalence of obesity increased from 23% to 31%. These overlapping secular trends have prompted some investigators to propose pharmaceutical iatrogenesis as a significant contributor to the obesity epidemic. The primary objective of our proposed research is to examine the relationship between the choice of depression treatment, including pharmacotherapy as well as psychotherapy, and the long-term risk of weight gain on the population level. It would be prohibitively expensive to conduct a prospective randomized trial to address this objective. Therefore, we propose a retrospective observational study of more than 50,000 individuals with a new diagnosis of depression in an integrated health plan and care-delivery system from 2005 to 2009. The study will take advantage of our health care system's provision of comprehensive patient care with sophisticated electronic data systems that allow efficient identification of large populations with depression and obesity as well as assessments of long-term changes in body weight, health status, and health care use. Our specific aims will describe the natural history of body weight change among adults with a new diagnosis of depression, examine the association between obesity and processes of depression care among adults with a new diagnosis of depression, and assess for differences in the trajectory of body weight change across individual antidepressants in a cohort of new antidepressant users. The analyses will integrate the disciplines of psychiatry, pharmacoepidemiology, primary care, biostatistics, and health services research to comprehensively address the relationship between obesity and depression care. This project will make novel use of the health care delivery system to investigate the epidemiology of weight gain in ways that could have broad-reaching implications for depression treatment in primary and specialty settings as well as future epidemiological studies of obesity. PUBLIC HEALTH RELEVANCE: Obesity and depression are major public health concerns that have substantial impacts on medical morbidity, health care expenditures, and quality of life. This project will make novel use of data from an integrated health plan and health care delivery system to investigate the hypothesis that the risk of long-term weight gain is related to the choice of antidepressant treatment among adults with depression. Our specific aims will integrate the disciplines of psychiatry, pharmacoepidemiology, primary care, biostatistics, and health services research to comprehensively address the relationship between obesity and depression care.