Depression as a predictor of weight regain among successful weight losers in the diabetes prevention program

David W Price, Yong Ma, Richard R Rubin, Leigh Perreault, George A Bray, David Marrero, William C Knowler, Elizabeth Barrett-Connor, D Yvette Lacoursiere, Diabetes Prevention Program Research Group, David W Price, Yong Ma, Richard R Rubin, Leigh Perreault, George A Bray, David Marrero, William C Knowler, Elizabeth Barrett-Connor, D Yvette Lacoursiere, Diabetes Prevention Program Research Group

Abstract

Objective: To determine whether depression symptoms or antidepressant medication use predicts weight regain in overweight individuals with impaired glucose tolerance (IGT) who are successful with initial weight loss.

Research design and methods: A total of 1,442 participants who successfully lost at least 3% of their baseline body weight after 12 months of participation in the randomized controlled Diabetes Prevention Program (DPP) continued in their assigned treatment group (metformin, intensive lifestyle, or placebo) and were followed into the Diabetes Prevention Program Outcome Study (DPPOS). Weight regain was defined as a return to baseline DPP body weight. Participant weight and antidepressant medication use were assessed every 6 months. Depression symptoms (Beck Depression Inventory [BDI] score ≥11) were assessed every 12 months.

Results: Only 2.7% of the overall cohort had moderate to severe depression symptoms at baseline; most of the participants with BDI score ≥11 had only mild symptoms during the period of observation. In unadjusted analyses, both depression symptoms (hazard ratio 1.31 [95% CI 1.03-1.67], P = 0.03) and antidepressant medication use at either the previous visit (1.72 [1.37-2.15], P < 0.0001) or cumulatively as percent of visits (1.005 [1.002-1.008], P = 0.0003) were predictors of subsequent weight regain. After adjustment for multiple covariates, antidepressant use remained a significant predictor of weight regain (P < 0.0001 for the previous study visit; P = 0.0005 for the cumulative measure), while depression symptoms did not.

Conclusions: In individuals with IGT who do not have severe depression and who initially lose weight, antidepressant use may increase the risk of weight regain.

Trial registration: ClinicalTrials.gov NCT00004992 NCT00038727.

Figures

Figure 1
Figure 1
Cumulative incidence of weight regain by DPP treatment group.
Figure 2
Figure 2
Depression symptoms and antidepressant medication use over time among participants who achieved at least 3% weight loss.

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