Rihmer Zoltán, Purebl György, Faludi Gábor, Halmy László
Semmelweis Egyetem, Klinikai és Kutatási Mentálhigiénés Osztály.
Neuropsychopharmacol Hung. 2008 Oct;10(4):183-9.
It has been long known that the frequency of overweight and obese people is higher among depressed and bipolar patients than in the general population. The marked alteration of body weight (and appetite) is one of the most frequent of the 9 symptoms of major depressive episode, and these symptoms occur during recurrent episodes of depression with a remarkably high consequence. According to studies with representative adult population samples, in case of obesity (BMI over 30) unipolar or bipolar depression is significantly more frequently (20-45%) observable. Since in case of depressed patients appetite and body weight reduction is observable during the acute phase, the more frequent obesity in case of depressed patients is related (primarily) not only to depressive episodes, but rather to lifestyle factors, to diabetes mellitus also more frequently occurring in depressed patients, to comorbid bulimia, and probably to genetic-biological factors (as well as to pharmacotherapy in case of medicated patients). At the same time, according to certain studies, circadian symptoms of depression give rise to such metabolic processes in the body which eventually lead to obesity and insulin resistance. According to studies in unipolar and bipolar patients, 57-68% of patients is overweight or obese, and the rate of metabolic syndrome was found to be between 25-49% in bipolar patients. The rate of metabolic syndrome is further increased by pharmacotherapy. Low total and HDL cholesterol level increases the risk for depression and suicide and recent studies suggest that omega-3-fatty acids possess antidepressive efficacy. Certain lifestyle factors relevant to healthy metabolism (calorie reduction in food intake, regular exercise) may be protective factors related to depression as well. The depression- and possibly suicide-provoking effect of sibutramine and rimonabant used in the pharmacotherapy of obesity is one of the greatest recent challenges for professionals and patients alike.
长期以来，人们一直知道，抑郁症和双相情感障碍患者中超重和肥胖人群的比例高于普通人群。体重（和食欲）的显著改变是重度抑郁发作的9种症状中最常见的症状之一，这些症状在抑郁复发期间出现，后果极为严重。根据对具有代表性的成年人群样本的研究，在肥胖（BMI超过30）的情况下，单相或双相抑郁症的发生率明显更高（20%-45%）。由于在抑郁症患者的急性期可观察到食欲和体重下降，抑郁症患者中更常见的肥胖不仅（主要）与抑郁发作有关，还与生活方式因素、抑郁症患者中也更频繁出现的糖尿病、共病的贪食症以及可能的遗传生物学因素（以及用药患者的药物治疗）有关。同时，根据某些研究，抑郁症的昼夜节律症状会在体内引发这样的代谢过程，最终导致肥胖和胰岛素抵抗。根据对单相和双相情感障碍患者的研究，57%-68%的患者超重或肥胖，双相情感障碍患者的代谢综合征发生率在25%-49%之间。药物治疗会进一步增加代谢综合征的发生率。总胆固醇和高密度脂蛋白胆固醇水平低会增加抑郁和自杀风险，最近的研究表明，ω-3脂肪酸具有抗抑郁功效。某些与健康代谢相关的生活方式因素（减少食物摄入量中的卡路里、定期锻炼）也可能是与抑郁症相关的保护因素。肥胖药物治疗中使用的西布曲明和利莫那班的促抑郁和可能的促自杀作用是专业人员和患者近期面临的最大挑战之一。
