510036 Vortragsreihe Medizinische Forschung: "Addressing the dual challenge: depression and obesity in primary care" (1 UE) (V+Ko) (SoSe 2024)

Obesity and depression are highly comorbid and are among the leading contributors to preventable diseases and disability worldwide. Both conditions are associated with problems such as social stigma, low self-esteem, and increased healthcare costs. Depression and obesity share common dysregulated physiological pathways, including inflammation, oxidative stress, mitochondrial dysfunction, neurotransmitter imbalances, HPA axis dysregulation, alterations in gut microbiota, and disturbances in the serotonin, norepinephrine, and dopamine systems. The co-occurrence of these conditions, often seen in primary care settings, exacerbates these problems. The relationship between obesity and depression is complex and varies by race, education, depression subtype, gender, and genetic polymorphism. Management of depression comorbid with obesity is challenging. Patients with excess weight may respond poorly to treatment with certain antidepressants (ADs). Conversely, the weight-increasing (obesogenic) effects of ADs may aggravate obesity-related health problems, including an increased risk for additional AD-related adverse effects. Moreover, patients with obesity may face an "obesity bias," a negative attitude that may influence the decision-making of healthcare professionals. An example of such a bias is when psychotherapy is bypassed in favor of pharmacological treatment. This can contribute to the high prevalence of ADs prescriptions in overweight people with depression. Our analyses of the large Canadian primary care databases using traditional statistics and a machine learning approach showed a positive association between obesity and prescribing a high number of ADs with obesogenic and cardiovascular adverse effects in patients with depression. Another worrisome trend observed was an increased risk of hospitalization in patients with obesity and depression who were prescribed obesogenic ADs. Clinicians, researchers, and policy makers should address the important issues of managing patients with both conditions in primary care. Possible rectification measures and future research directions will be presented and discussed during the lecture.

Requirements for participation, required level

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