Bupropion SR helps depressed obese patients: 50-week study.

SAN FRANCISCO -- Twenty-four percent of 140 obese patients with depression lost 10% or more of their initial, body weight during up to 50 weeks on slow-release bupropion, Dr. Paul S. Bradley reported at the annual meeting of the American Psychiatric Association.

The study showed that 51% of patients lost 5% or more of their baseline body weight, an amount considered medically significant.

These findings underscore bupropion SR's dual utility as an antidepressant and weight loss agent. That's a highly desirable one-two punch, given that roughly two-thirds of Americans are now overweight or obese, and that 10% of adults experience an episode of major depression in any given year, said Dr. Bradley, who is in group practice in Savannah, Ga.

He reported on 231 obese depressed patients who completed a double-blind 26-week clinical trial involving randomization to either 300-400 mg/day of bupropion SR or placebo.

Of those patients, 211 elected to continue on in a 24-week open-label phase. The participants had a baseline score of 10-30 on the Beck Depression Inventory--Second Edition (BDI-II), with a mean of 15, but they did not meet diagnostic criteria for major depression.

Of the 140 patients who completed all 50 weeks of the study, 76 had been on bupropion SR the whole time, while 64 spent 26 weeks on placebo followed by 24 weeks on the antidepressant.

Mean weight loss in the 140 patients who completed me study was 5.9 kg, or 6.3% of their initial body weight.

Total cholesterol decreased by a mean 11.4 mg/dL, LDL by 7.8 mg/dL, and hemoglobin [A.sub.1c] by 0.20%. However, the study showed that HDL cholesterol rose by 2.6 mg/dL.

Study participants were encouraged to adhere to a weight-loss diet providing them with a 500-kcal/day deficit throughout the 50 weeks.

Of note, only 5% of patients achieved a 10% or greater weight loss after 26 weeks on diet-plus-placebo, compared with 32% following the switch from placebo to bupropion.

Depressive symptoms continued to improve over time in response to bupropion.

Among patients who were randomized to the drug in the double-blind phase of the study, 47% showed a significant response after 26 weeks as defined by at least a 50% reduction from baseline in BDI-II scores.

By week 50, this figure had climbed to 62% among the patients. Forty-two percent of patients showed a significant response to placebo in the double-blind phase, inching up to 45% at week 50 after 24 weeks on bupropion.

A significant correlation was observed between weight loss and antidepressant efficacy, Dr. Bradley reported at the meeting.

The study showed that patients who lost at least 5% of their body weight during the 50-week study were 2.6-fold more likely to experience a 50% or greater reduction in BDI-II scores.

Bupropion SR is a norepinephrine and dopamine reuptake inhibitor approved for treatment of depression and for smoking cessation. Use of the drug for weight control is off label.

Prior studies have indicated that the drug is weight neutral in depressed patients who are not overweight or obese, but may be associated with weight loss in depressed patients who are overweight or obese.

In addition, several recent studies have concluded that bupropion is an effective adjunct to dietary weight loss in nondepressed patients, according to Dr. Bradley.

His study was funded by GlaxoSmithKline.

BRUCE JANCIN

Denver Bureau