Bupropion SR and weight loss - Effects of Obesity on Different Aspects of Life

Nutrition Research Newsletter, Nov, 2002 by Adesh K. Jain, Roy A. Kaplan, Kishmore M. Gadde

Bupropion sustained-release (bupropion SR) is a norepinephrine and dopamine reuptake inhibitor currently marketed for depression and smoking cessation. Although the nature of the causal relationship, if any, between obesity and depressive symptoms remains to be elucidated, the literature suggests that the two co-occur more often among patients seeking treatment for obesity than in either the general population or among non-treatment seeking obese patients.

Bupropion SR is associated with weight loss in overweight or obese depressed patients. A current randomized, double-blind, placebo-controlled study in Obesity Research evaluated the efficacy and tolerability of bupropion SR in facilitating weight loss and reducing depressive symptoms in obese adults with depressive symptoms.

A total of 229 men and women between 18 and 70 years of age with a BMI of 30 to 44 kg/[m.sup.2] and a Beck Depression Inventory (BDI-II) score indicative of depressive symptoms but not diagnosed with Major Depressive Disorder were included in this study. The study consisted of a screening visit, a run-in period, and a 26-week double-blind treatment period. The patients received 300 mg/day or placebo of bupropion SR for 26 weeks with a 500 kcal/day deficit diet. Patients who lost <5% of baseline weight at week 12 had bupropion SR dosage or placebo increased to 400 mg/day in a blinded fashion. The primary efficacy measures were mean change from baseline body weight at week 26 and percentage of patients with at least a 50% reduction in BDI-II score from baseline to week 26. Body weight and BDI-II scores were measured at the screening visit, twice during the run-in period and at treatment weeks 2,4,6, 8, 12, 16,20,24, and 26.

Bupropion SR was well-tolerated among the subjects who received it. The bupropion SR group lost an average of 4.4 kg as against 1.7 kg on the placebo. More patients in the treatment group than in the placebo group lost at least 5% of baseline weight. The percentage of patients reporting > 50% decrease in depressive symptoms did not differ between groups, but depressive symptoms improved more with bupropion SR than with placebo among patients with a history of major depression. In the sample as a whole, improvement in depressive symptoms was related to weight loss of >5% regardless of treatment.

The findings indicate that bupropion SR in conjunction with a 500 kcal/day deficit diet was significantly more effective than the placebo at reducing weight in obese patients with depressive symptoms. Depressive symptoms improved throughout the study in both treatment groups, but post hoc analysis indicated that the improvement in depressive symptoms was related to weight loss instead of treatment. This finding suggests the possibility that at least some of the depressive symptoms were secondary to obesity.

Adesh K. Jain, Roy A. Kaplan, Kishmore M. Gadde, et al., Bupropion SR vs. placebo for weight loss in obese patients with depressive symptoms, Obesity Research 10(10): 1049-1056 (October 2002) [Address correspondence to Adesh Jain, M.D., Medical Research Institute Inc., 1051 Gause Blvd., Suite 330, Slidell, LA 70458. E-mail:ajain@medresearch.com]