Remission outcomes with bupropion versus selective serotonin reuptake inhibitor monotherapy in major depressive disorder with comorbid obesity: A propensity-matched cohort analysis.

Observational and secondary analyses of clinical trials evaluating efficacy of antidepressants suggest that medications with noradrenergic and dopaminergic mechanisms of action may be more effective in managing symptoms of major depressive disorder (MDD) in obese patients than medications that are purely serotonergic. The purpose of this study is to compare the efficacy of bupropion versus SSRIs in patients without a documented antidepressant trial with comorbid MDD and obesity. This was a retrospective, propensity-score matched, observational study utilizing a global cohort within the TriNetX database. Adults aged 18 or over with a major depressive episode and obesity were grouped into two cohorts: 1) exposure to bupropion and 2) exposure to SSRIs. Patients with antidepressant exposure prior to the index event were excluded. Both cohorts were propensity matched based on 16 covariates. The primary outcome was remission of a major depressive episode. Secondary outcomes included evaluating socioeconomic and psychosocial differences between the groups. Each cohort yielded 165,629 patients. The primary endpoint analysis indicated a small but statistically significant difference in MDD remission rates in favor of bupropion with an absolute risk rate of 8.5% compared to 7.9% in the SSRI group (Risk Ratio [RR] 1.07, 95% CI 1.05-1.10, p < 0.0001). Binary outcomes were summarized using risk differences and risk ratios and compared between cohorts using chi-square tests. Our findings suggest bupropion monotherapy was associated with a small but statistically significant higher remission rate compared with SSRIs but further prospective studies using objective remission indicators are needed.