Personalizing antidepressant choice by sex, body mass index, and symptom profile: An iSPOT-D report

Abstract

Antidepressants are efficacious but we do not know which antidepressant is best suited to which person. We investigated the working hypothesis that obesity and sex may together be differential predictors of acute remission of specific symptoms for commonly used antidepressant medications. Data were acquired for 659 outpatients (18–65years of age) who completed the iSPOT-D practical randomized controlled clinical trial. We measured adiposity by body mass index (BMI). By WHO criteria, 42% of patients were normal weight, 28% overweight and 31%, obese [class I (15%), II (10%) and III (6%)]. Patients were randomly assigned to 8-weeks of treatment with escitalopram, sertraline or venlafaxine extended-release (venlafaxine-XR) and then defined as remitters (17-item Hamilton Rating Scale for Depression score ⩽7) or non-remitters. In logistic regression models, BMI was a differential predictor of remission according to antidepressant type. Morbidly obese patients, compared to those with normal weight, were more likely to remit on venlafaxine-XR in particular. This effect was driven by a reduction specifically in physical symptoms, including sleep disturbance, somatic anxiety and appetite. The number needed to treat to achieve remission with venlafaxine-XR in obese III participants was 6. Higher BMI females but not males were more likely to remit regardless of medication type; this effect was related to a change in cognitive symptoms, including suicidal ideation, guilt, and psychomotor changes. Our findings suggest that considering BMI and sex, and assessing specific symptoms, could help tailor antidepressant choices to improve remission from depression in specialty and primary care settings.