Received 8 October 2008; accepted 30 December 2008. published online 23 February 2009.
Abstract
Introduction
Obesity is currently considered a global epidemic and its prevention and treatment is a major public health concern, demanding treatment which may combine a sociocultural approach, lifestyle modification, nutritional, pharmacological or surgical strategies. Rimonabant, an endocannabinoid antagonist, has been proposed as an agent for an average weight loss of 4 kg. However, the development of anxiety and depressive symptoms can be major side effects.
Case Report
A 27-year-old businessman, after using rimonabant (20 mg/day) for 1 month for weight loss, developed a major depressive episode with melancholic features, which remitted after the interruption of rimonabant.
Discussion
To our knowledge, a major depressive episode with melancholic or atypical features specifier has not been described since the initiation of rimonabant pharmacological trials. The Hospital Anxiety and Depression Scale, used in the rimonabant trials, assesses several key points of depressive patients. However, it neglects the somatic symptoms that correspond to the additional criterion for both of the mentioned features as well as suicidal ideation. The severity of an episode could also be underestimated depending on the assessment tool or on the clinical interview.
Conclusion
There may be an underestimation of depressive melancholic and atypical side effects related to Rimonabant use, due to the lack of consistent assessment with the appropriate screening tools. Pharmacological strategies should be adjunctive for obesity treatment when there is a failure in the lifestyle and nutritional modification strategies. Moreover, deeper global sociocultural changes should be made in the treatment and control of the global obesity epidemic.
aPsychiatry Service, Hospital das Clínicas (HC-UFMG), Federal University of Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
bDepartament of Medical Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto (MG), Brazil
cPsychiatry Service, Hospital das Clínicas (HC-UFMG), Federal University of Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
dDepartment of Mental Health, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
Corresponding author. Serviço de Psiquiatria do Hospital das Clínicas da Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena 110, Santa Efigênia. Belo Horizonte, MG, Brasil. CEP: 30130-100. Tel.: +55 31 3409 9458; fax: +55 31 3409 9458.
ABSTRACT