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ObjectiveTo examine the association between antidepressant use and weight gain, as well as the interaction with lifestyle factors.DesignLongitudinal study.Setting and participantsWe used data from 2334 adults from two stages (4.4 years apart) of the North West Adelaide Health Study, including validated diet and lifestyle questionnaires, measured body weight and linked pharmaceutical prescription data.Main outcome measuresBody weight change.Results188 (8.1%) participants had a mean annual number of 1–2 antidepressant prescriptions, and 212 (9.1%) had over two prescriptions. The mean annual weight gain was 0.12, 0.18 and 0.28 kg in non-users, low (1–2 prescriptions/year) and high (>2 prescriptions/year) antidepressant users, respectively. In multivariable regression models, antidepressant use was positively associated with weight gain: high antidepressant users gained an extra 0.22 (95% CI 0.00 to 0.44) kg per year. This association was mainly due to selective serotonin reuptake inhibitor (SSRI) use. High SSRI users gained 0.48 (95% CI 0.20 to 0.76) kg more than non-users. There was no association between tricyclic or other antidepressant use and weight gain. The association between SSRI use and weight gain was stronger among those with high intake of Western diet, greater sedentary activity, and who smoked.ConclusionsSSRIs use was associated with weight gain in the presence of unhealthy behaviours including Western diet, sedentarism and smoking.

Objective The collaborative care model is recommended for depression in adults with a chronic physical health problem like diabetes. We sought to systematically assess the effect of collaborative care on depression and glycaemia in adults with comorbid depression and diabetes to inform guidelines and practice. Design Systematic review and meta-analysis. Data sources We searched PubMed, Scopus, Cochrane Library, CINAHL, Health Source Nursing, MEDLINE, PsychINFO and reference lists of retrieved articles published before August 2013. Inclusion criteria Randomised controlled trials (RCTs) on collaborative care (ie, coordinated multidisciplinary model of care) for depression that reported the effects on depression and glycaemic outcomes in adults with comorbid clinically relevant depression and diabetes were eligible. Data extraction and analysis Data on the mean difference in depression and glycaemic outcomes were extracted and pooled using random effects meta-analysis. Results Seven RCTs included for review reported effects on depression outcomes in 1895 participants, and glycated haemoglobin (HbA1c) level in 1556 participants. Collaborative care significantly improved the depression score (standardised mean difference was −0.32 (95% CI −0.53 to −0.11); I 2 =79%) and HbA1c level (weighted mean difference was −0.33% (95% CI −0.66% to −0.00%); I 2 =72.9%) compared with control conditions. Depression remission did not predict better glycaemic control across studies. Conclusions Limited evidence from short-to-medium term RCTs predominantly conducted in the USA suggests that collaborative care for depression significantly improves both depression and glycaemia outcomes, independently, in people with comorbid depression and diabetes.

Clinicians should be aware that the association can occur in both directions Obesity and common mental disorders, such as anxiety and depression, independently account for a substantial proportion of the global burden of disease and its associated economic costs, so it is important to determine the interaction between the two conditions. In the linked prospective cohort study (British Whitehall Study II; doi:10.1136/bmj.b3765), Kivimaki and colleagues looked for a bidirectional association between obesity and common mental disorders.1 Between 1985 and 1988, they recruited civil servants who were aged 35-55 years at baseline and studied them in three waves over 19 years. They found that common mental disorders were associated with an increased risk of obesity, and that the risk of obesity increased with the number of episodes of depression or anxiety. In contrast, they found weaker non-significant associations between obesity and the risk of common mental disorders. Kivimaki and colleagues’ findings are consistent with previous cohort studies showing that baseline depression or anxiety predict obesity,2 3 4 but …