Excess body weight may predict treatment response for certain antidepressant medications in adults with depressive disorder, according to a study published in the Journal of Affective Disorders.

Investigators performed a comprehensive scoping review of the literature to assess differences in terms of antidepressant treatment response between adult patients with depression who were overweight vs those who were normal weight. The review included a total of 12 studies that were conducted between 2004 and 2019 from the MEDLINE and PsychINFO databases. Treatments for depression in these studies included antidepressants:  selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), tetracyclic antidepressants (TeCA), and dual action antidepressants.

A total of 11 (91.7%) studies reported an association between BMI, weight status, or obesity class and the efficacy of antidepressant therapy. Approximately 75% (n=9) of the studies suggested that patients with a high BMI had clinically poor response to treatment with nortriptyline, fluoxetine, or other antidepressant medications. In an open label randomized controlled trial of patients with major depressive disorder, those who were overweight and obese had a slower improvement in symptoms with antidepressants compared with patients who were of normal weight.

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In another study, bupropion and escitalopram combination therapy was associated with greater benefits than escitalopram monotherapy in patients with morbid obesity (BMI >35 kg/m2). The use of venlafaxine XR was associated with improvements in depressive symptoms in another study of patients with morbid obesity. A study found that sex modified the association between BMI and changes in cognitive symptoms. Women with a high BMI in this study had a greater likelihood of improvement compared with men.

Limitations of the review included the reliance on only 2 research databases (MEDLINE and PsychINFO) and the focus on studies comprising only adult populations.

The researchers suggested that their “findings may be useful to physicians in their decision regarding the choice of antidepressant medication in patients with excess weight.”


Puzhko S, Aboushawareb SAE, Kudrina I, et al. Excess body weight as a predictor of response to treatment with antidepressants in patients with depressive disorder. J Affect Disord. 2020;267:153-170.