Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant use van Reedt Dortland AKB, Giltay EJ, van Veen T, Zitman FG, Penninx BWJH. Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant use. Objective: The metabolic syndrome (MetSyn) predisposes to cardiovascular disease and diabetes mellitus. There might also be an association between the MetSyn and anxiety and depression, but its nature is unclear. We aimed to investigate whether diagnosis, symptom severity and antidepressant use are associated with the MetSyn. Method: We addressed the odds for the MetSyn and its components among 1217 depressed and ⁄ or anxious subjects and 629 controls, and their associations with symptom severity and antidepressant use. Results: Symptom severity was positively associated with prevalence of the MetSyn, [adjusted odds ratio (OR) 2.21 for very severe depression: 95% confidence interval (CI): 1.06–4.64, P = 0.04], which could be attributed to abdominal obesity and dyslipidemia. Tricyclic antidepressant (TCA) use also increased odds for the MetSyn (OR 2.30, 95% CI: 1.21–4.36, P = 0.01), independent of depression severity. Conclusion: The most severely depressed people and TCA users more often have the MetSyn, which is driven by abdominal adiposity and dyslipidemia. A. K. B. van Reedt Dortland 1 , E. J. Giltay 1 , T. van Veen 1 , F. G. Zitman 1 , B. W. J. H. Penninx 1,2,3 1 Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands, 2 Department of Psychiatry, VU University Medical Centre, Amsterdam, the Netherlands and 3 Department of Psychiatry, University Medical Centre Groningen, Groningen, the Netherlands Key words: depression; anxiety; metabolic syndrome; abdominal obesity; dyslipidemia; tricyclic antidepressants Arianne K.B. van Reedt Dortland, Leiden University Medical Centre, Department of Psychiatry, B1-P, PO Box 9600, 2300 RC, Leiden, the Netherlands. E-mail: akbvanreedtdortland@lumc.nl Accepted for publication March 18, 2010 Significant outcomes • Metabolic syndrome alterations are most prominent in subjects with more severe depressive symptoms, rather than among distinct DSM-IV diagnosis groups. • Abdominal adiposity and dyslipidemia were the components of the metabolic syndrome that showed the strongest association with psychopathology. • Tricyclic antidepressant (TCA) use was also associated with an increased prevalence of metabolic syndrome alterations. Limitations • The cross-sectional design of the study does not allow for causative inferences on the relationship between psychopathology characteristics and metabolic syndrome alterations. • As a result of the relatively small number of TCA users, some imprecision of effect estimates of the actual associations between TCA use and metabolic syndrome alterations might have occurred. • Prospective studies on the metabolic effects of TCA are warranted. Acta Psychiatr Scand 2010: 122: 30–39 All rights reserved DOI: 10.1111/j.1600-0447.2010.01565.x Ó 2010 John Wiley & Sons A/S ACTA PSYCHIATRICA SCANDINAVICA 30