Nearly a decade ago, Steers and Lee (2001) published a landmark study focusing attention on the correlation between major depression and urinary incontinence. While both medical conditions have long been known to disproportionately affect women and to have a significant, negative impact on quality of life, it was not until pharmacological research demonstrated the efficacy of serotonin-norepinephrine reuptake inhibitors, the SSRI agents used in popular antidepressant medications, in reducing symptoms of stress urinary incontinence (SUI) that everyone began taking a closer look. Eli Lilly, the manufacturer of Cymbalta® (duloxetine HCL), markets the SSRI for the management of depression but elected not to pursue final FDA clearance to market a sister drug in a slightly different dosage for SUI in the U.S. as it does currently in several dozen countries elsewhere. Although the exact way that Cymbalta works in people is unknown, it is believed to be related to an increase in the activity of serotonin and norepinephrine which are two naturally occurring substances in the brain and spinal cord. One thing is certain: depression is not just a passing mood. It is grounded in physiological phenomena and not something that can be "wished" away.
Even women with a different type of bladder control problem - overactive bladder (OAB) - are two to three times more likely than non-sufferers to experience very often difficulties concentrating, tiredness, and lack of self-esteem, symptoms frequently associated with depression, according to consumer responses to a nationwide survey by NAFC (2005). Making health matters worse, the survey revealed that OAB sufferers are statistically less likely to go for long walks or exercise regularly, contributing further to compromised health status.
Researchers at Princeton, Dartmouth and the University of Colorado have recently unearthed why exercise makes us "brighter" and less anxious. In comparing the brains of rats that engaged in aerobic, endurance-type activities to those of slothful rats, the active rats were found to have produced more new brain cells (neurons) that were buffered from exposure to stress (a cold water bath in the lab experiment). Biochemically, the brains of these rats were molecularly calmer. While we have long believed that exercise enhances mood, we haven't really understood how activity might affect psychological states. The role of serotonin was simplistically credited for the "happy" brain for decades. What researchers now believe is that the positive stress of exercise physiologically prepares cells and structures within the brain so they are even better equipped to handle life's stresses in other forms. The story is summarized in The New York Times by Gretchen Reynolds.
This discussion brings me back to the connection between depression and incontinence. If you fear the embarrassment of an accident in public while exercising and therefore shun a heart-pumping routine, you are reducing your own body's ability to cope with anxiety and stress. That can lead to feelings of inadequacy, lower productivity, and consequently poorer self-esteem, not to mention the fact that exercise is key to weight loss and management. In this regard, researchers at UCSF have demonstrated a clear, causal link between obesity and SUI by showing dramatic reductions in symptoms with a small to modest weight loss.
Bottom line, incontinence is connected to depression, and both are legitimate medical conditions. There's help for both. Get diagnosed. Get in treatment. Make exercise an uplifting, self-renewing part of your daily routine. And if you want some help and support, visit HealthCentral's Depression site.
Published On: January 06, 2010