Depression and Weight Gain
Depression and weight gain often seem to come as a combined and unwelcome package. It's also something of a conundrum. Does weight gain lead to depression, or does depression lead to weight gain? Is it some combination of the two, or is a third factor involved?
We have to start by unpicking some of these issues. Weight gain does not, of itself, necessarily lead to depression. There are plenty of very overweight people out there who have a high level of self-esteem and who seem perfectly content with their lives. Then, of course, there are overweight people who feel completely miserable. Chances are they are on the sharp edge of life as an overweight person. Maybe they feel their weight is preventing relationships developing, or holding down a job, or buying the clothing they'd like to wear? Perhaps they feel tired and breathless and knowledgeable of health problems associated with being overweight? Maybe they are all too aware of the vicious circle they find themselves in. They are unhappy so they eat and drink for comfort, and then feel guilty over their lack of restraint.
Depression does not necessarily lead to weight gain. It is however common for diet to be affected during depression. In some people this may lead to weight loss, whilst in others it results in weight gain. We then have to factor in that many people with depression don't recognize the symptoms in themselves. They feel unhappy and ill at ease with their situation and typically look to physical signs and symptoms as a way to explain these symptoms. One of the clearest signs is weight gain and so weight gain may become the focus of attention.
Recent research indicates that a body mass index of 30 or more increases a person's risk of depression by 50 percent to 150 percent. Dr. Gregory Simon, M.D., the lead author, focused on two weight loss strategies. The first focused on weight loss only and the second focused on weight loss and depression. Women who were untreated for depression found weight loss much more difficult. Another feature of the study highlights the relationship between activity, weight and depression. During depression, physical activity tends to reduce considerably. This in turn promotes weight gain. If physical activity is promoted it not only helps to reduce weight but symptoms of depression are also lifted.
Treating depression can be a fairly complex issue. Whilst the relationship between physical activity and weight can be viewed as going in both directions, it doesn't add up to a full understanding or treatment for depression. In cases of major depression antidepressant medication may be essential and one of the side-effects of some antidepressants is weight gain. Many patients are put off antidepressants because of the potential for weight gain and whilst not all antidepressants have weight gain as a side effect, they do not work for all people. Short-term weight gain may be the price some people have to pay in order to elevate their mood state.
Weight gain and depression remains a thorny issue. In time the side effect of weight gain with antidepressants may be resolved. In terms of weight loss programs, Dr. Roshanaei-Moghaddam, of the University of Washington in Seattle, states "most weight loss programs do not pay enough attention to screening and treatment of depression". Weight loss programs are big business but most focus on dietary issues and self-reward as the main scheme for progress. In cases where weight gain is the main cause of depression the strategy is more likely to work, but where depression is the cause or a major contributor to weight gain, the outlook is far less optimistic. This further underscores the need for more joined-up thinking and action.
Simon GE, et al. Association between change in depression and change in weight among women enrolled in weight loss treatment. Gen Hosp Psych, 32(6), 2010.