Treatment of abdominally obese men with a serotonin reuptake inhibitor: a pilot study

Objective. To investigate the effects of a selective serotonin reuptake inh ibitor (SSRI) on the neuroendocrine and autonomic nervous system perturbati ons found in abdominal obesity. Design. Treatment for 6 months with citalopram and for 6 months with placeb o using a double-blind, cross-over design, with a 2-month wash-out period b etween treatment periods. Subjects. Sixteen healthy men, 45-60 years, moderately obese and with an ab dominal fat distribution. Measurements. Anthropometry, three different depression rating scales, seru m lipids, testosterone, IGF-I, oral glucose tolerance test (OGTT), pituitar y stimulation with corticotropin releasing hormone (CRH), arithmetic stress test, and excretion of cortisol and metoxycatecholamines in urine, collect ed during 24 h. Results. Cortisol concentrations in the morning were low before treatment, indicating a perturbed function of the hypothalamic-pituitary-adrenal (HPA) axis. After treatment with citalopram morning cortisol concentrations rose to normal. Cortisol concentrations after stimulation with CRH or stress we re elevated by citalopram treatment, but urinary cortisol excretion was unc hanged. The glucose concentrations after OGTT (120 min) tended to be reduce d, with unchanged insulin concentrations, whilst other metabolic values did not change during treatment. Heart rate after administration of CRH, and d uring laboratory stress test, decreased by treatment with citalopram. Diurn al urinary excretion of metoxycatecholamines tended to decrease. Neither bo dy mass index nor waist/hip circumference ratio decreased. Depression score s were within normal limits before treatment and did not change. Conclusion. The results of this pilot study indicate improvements in the re gulation of neuroendocrine-autonomic systems as well as metabolism in abdom inal obesity during treatment with an SSRI.