Relapse After Antipsychotic Discontinuation in Schizophrenia as a Withdrawal Phenomenon vs Illness Recurrence

Abstract

Background: Although depression and obesity are bidirectionally associated, little is known about weight changes following major depressive disorder (MDD). This study compared 2-year weight changes between patients with current MDD (cMDD), patients with remitted MDD (rMDD), and healthy controls. Additionally, we examined the relationship between antidepressant medication use and 2-year weight change. Method: Data from 2,542 adults aged 18–65 y were sourced from the Netherlands Study of Depression and Anxiety. Data were collected at baseline and after 2, 4, and 6 years (September 2004–April 2013). Depression status (DSM-IV criteria for MDD) was established with the Composite International Diagnostic Interview. Subsequent 2-year weight changes were categorized as weight loss (> 5% loss), weight stable (within 5% weight loss or gain), and weight gain (> 5% gain). The association of depression status with subsequent weight change, with weight stable as reference category, was studied by combining all repeated measurements in a mixed multinomial logistical regression model. Results: cMDD, but not rMDD, was significantly associated with both weight gain and weight loss over a 2-year period after adjustment for covariates (odds ratio [OR] = 1.67; 95% confidence interval [CI], 1.37–2.03; P < .001; and OR = 1.27; 95% CI 1.01–1.61; P = .045, respectively). Antidepressant use was associated with weight gain (SSRIs: OR = 1.26; 95% CI, 1.05–1.52; other antidepressants: OR = 1.36; 95% CI, 1.00–1.84; P < .05 for both), but not after considering depression status. Compared to cMDD patients who lost weight, those who gained weight had lower initial weight, were younger, had more comorbid anxiety disorders, and reported poorer quality of mood and reduced appetite as depressive symptoms. Conclusions: Compared to controls, cMDD participants have greater odds of either gaining or losing weight over a 2-year period, regardless of antidepressant use.