Department of Psychiatry, University of Toronto, Canada.
J Clin Psychiatry. 2012 Aug;73(8):1119-24. doi: 10.4088/JCP.11m07394. Epub 2012 May 15.
While a significant body of research has demonstrated high comorbidity rates between depression and obesity, the vast majority of this work has considered depression as a unitary diagnosis. Given that increased appetite and weight gain are highly characteristic of the "atypical" subtype of depression, while classic depression is characterized by decreased appetite and weight loss, it would be important to examine whether increased obesity risk is consistent across the major vegetative subtypes of depression or is limited to the atypical subtype.
Using data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we identified 5,092 US adults with past or current major depression based on DSM-IV-TR criteria and 1,500 gender-matched controls. Each depressed subject was designated as having classic, atypical, or undifferentiated depression based on core vegetative symptoms. Logistic regression models examined rates of current obesity (defined as a current body mass index [kg/m2] > 30) across the 3 depressive subgroups and nondepressed controls, adjusting for demographic differences. To limit the possible effect of current depressive symptoms on observed obesity rates, secondary analyses were completed in individuals with past depression only.
Subjects with atypical depression had markedly elevated obesity rates compared to population controls and to other depressed subjects, with corresponding pairwise odds ratios consistently greater than 2.0 (P < .001). In contrast, obesity rates were not significantly different in subjects with classic depression and nondepressed controls. These results were manifest in individuals with either current or past depression and were independent of gender and age.
While many individuals with classic depression will present with obesity due to the high prevalence of both disorders, only atypical depression is associated with an elevated risk of obesity relative to the population at large. Refining the target phenotype(s) for future work on depression and obesity might improve our understanding, prevention, and treatment of this complex clinical problem.
尽管大量研究表明抑郁和肥胖之间存在高共病率，但绝大多数此类研究都将抑郁视为一种单一诊断。鉴于食欲增加和体重增加是“非典型”抑郁亚型的高度特征，而经典抑郁的特征是食欲减退和体重减轻，因此重要的是要研究肥胖风险增加是否与抑郁的主要植物神经亚型一致，或者是否仅限于非典型亚型。
我们利用 2001-2002 年全国酒精和相关情况流行病学调查（NESARC）的数据，根据 DSM-IV-TR 标准确定了 5092 名美国过去或现在患有主要抑郁症的成年人，以及 1500 名性别匹配的对照者。根据核心植物神经症状，每个抑郁患者被指定为患有经典、非典型或未分化抑郁。使用逻辑回归模型，根据当前的肥胖率（定义为当前体重指数（kg/m2）>30）在 3 个抑郁亚组和非抑郁对照组之间进行比较，调整了人口统计学差异。为了限制当前抑郁症状对观察到的肥胖率的可能影响，仅在过去患有抑郁症的个体中进行了次要分析。
与人口对照和其他抑郁患者相比，患有非典型抑郁的患者肥胖率明显升高，相应的配对比值比始终大于 2.0（P<0.001）。相比之下，经典抑郁患者的肥胖率与非抑郁对照组没有显著差异。这些结果在当前或过去患有抑郁症的个体中均表现明显，并且与性别和年龄无关。
虽然许多经典抑郁症患者由于两种疾病的高患病率而会出现肥胖症，但只有非典型抑郁症与肥胖症的风险升高有关，与普通人群相比。针对未来抑郁和肥胖症的研究，细化目标表型可能会改善我们对这一复杂临床问题的理解、预防和治疗。
