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Cited by 7Treatment of Major DepressionMental Health Treatment and AccessObesity and Health Practices

Evaluating prevalence and patterns of prescribing medications for depression for patients with obesity using large primary care data (Canadian Primary Care Sentinel Surveillance Network)

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Puzhko, Svetlana, Schuster, Tibor, Barnett, Tracie A., Renoux, Christel, Rosenberg, Ellen, Barber, David, Bartlett, Gillian·2020·Frontiers in Nutrition
DOI 10.3389/fnut.2020.00024PMC PMC7090027
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Abstract

Introduction: Depression is a serious disorder that brings a tremendous health and economic burden. Many antidepressants (AD) have obesogenic effects, increasing the population of obese patients at increased risk for a more severe disease course and poor treatment response. In addition, obese patients with depression may not be receiving the recommended standard of care due to “obesity bias”. It is important to evaluate prescribing pharmacological treatment of depression in patients with obesity. Objectives: To describe the prevalence and patterns of AD prescribing for patients with depression and comorbid obesity compared with normal weight patients, and to examine the association of prescribing prevalence with obesity class. Methods: Study sample of adult patients (>18 years old) with depression was extracted from the national Canadian Primary Care Sentinel Surveillance Network (CPCSSN) Electronic Medical Records database for 2011-2016. Measures were prescribing of at least one AD (outcome) and body mass index (BMI) to categorize patients into weight categories (exposure). Data were analyzed cross-sectionally using descriptive statistics and mixed effects logistic regression model with clustering on CPCSSN networks and adjusting for age, sex, and the comorbidities. Results: Of 120,381 patients with depression, 63,830 patients had complete data on studied variables (complete cases analysis). Compared with normal weight patients, obese patients were more likely to receive an AD prescription (adjusted Odds Ratio [aOR]=1.17; 95% Confidence Interval [CI]: 1.12-1.22). Patients with obesity classes II and III were 8% (95%CI: 1.00, 1.16) and 6% (95%CI: 0,98, 1.16) more likely, respectively, to receive AD. After imputing missing data using Multiple Imputations by Chained Equations, the results remained unchanged. The prevalence of prescribing > 3 AD types was higher in obese category (7.27%, [95%CI: 6.84, 7.73]) than in normal weight category (5.6%; [95%CI: 5.24, 5.99]). Conclusion: The association between obesity and high prevalence of AD prescribing and prescribing high number of different AD to obese patients, consistent across geographical regions, raises a public health concern. Study results warrant qualitative studies to explore reasons behind the difference in prescribing, and quantitative longitudinal studies evaluating the association of AD prescribing patterns for obese patients with health outcomes.

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  • A greater prescription of antidepressants in the most severe grades of obesity (classes II and III) is commonly observed.

    “Moreover, a greater prescription of antidepressants in the most severe grades of obesity (classes II and III) is commonly observed.”

    From Kefir and Intestinal Microbiota Modulation: Implications in Human Health (2021) · cites this paper as [84]

  • In a study performed in Canada, there was an association between obesity and high prevalence of antidepressants' prescription.

    “In a study performed in Canada, for example, there was an association between obesity and high prevalence of antidepressants' prescription.”

    From Kefir and Intestinal Microbiota Modulation: Implications in Human Health (2021) · cites this paper as [84]

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Authors
Puzhko, S., Schuster, T., Barnett, T. A., Renoux, C., Rosenberg, E., Barber, D., & Bartlett, G.
Affiliations
  • McGill University (CA)
  • Université du Québec à Montréal (CA)
  • Jewish General Hospital (CA)
  • Queen's University (CA)
Corresponding author
Bartlett, Gillian
ORCID
Venue
Frontiers in Nutrition
Publisher
Frontiers Media SA
Published
2020-03-17
Volume
7
Pages
24-24
ISSN
2296-861X (ISSN-L)
DOI
10.3389/fnut.2020.00024
PMC
PMC7090027
OpenAlex
W3011220284
Cited by
7
References
78
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2021: 2
FWCI
0.45
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Nutrition (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • EspaceINRS (National Institute for Scientific Research (Canada)) (submittedVersion)
  • HAL (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
Keywords
depression, obesity, antidepressant prescribing, weight bias, body mass index, obesity class, primary care, prescribing patterns, Canadian Primary Care Sentinel Surveillance Network, electronic health records, multiple imputation by chained equations, missing data imputation, regional variation in prescribing

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