[fusion_builder_container background_color=”” background_image=”” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ background_repeat=”no-repeat” background_position=”left top” video_url=”” video_aspect_ratio=”16:9″ video_webm=”” video_mp4=”” video_ogv=”” video_preview_image=”” overlay_color=”” overlay_opacity=”0.5″ video_mute=”yes” video_loop=”yes” fade=”no” border_size=”0px” border_color=”” border_style=”” padding_top=”20″ padding_bottom=”20″ padding_left=”” padding_right=”” hundred_percent=”no” equal_height_columns=”no” hide_on_mobile=”no” menu_anchor=”” class=”” id=””][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][fusion_text]Depression is the most common psychological barrier to long-term weight management success. Depression is a medical illness characterized by sadness, fatigue and loss of interest in usual activities. For many years depression has been hidden as a socially unacceptable condition but recent advances in the diagnosis and treatment have lead to greater understanding and more effective intervention in this all-too-common problem.
Lifetime prevalence of depression may be as high as 20% for adults. Many of these episodes are associated with emotional setbacks, family deaths or similar situational triggers. Even repeated smaller stressors are a cause of depression in some as the battering wears down the coping skills and self-esteem of individuals. If depression symptoms persist for more than two weeks they should be reviewed by a doctor and treatment considered. The success rate of treating depression is well over 80% in primary care and
probably exceeds the success rate of treating hypertension.
In overweight and obese individuals seeking weight loss and maintenance, depression may be as high as 40% at one point or another in their treatment. Treating depression is essential to weight loss success and most current therapies (including medications) do not conflict with modern weight loss programs. Some begin weight loss efforts with the additional burden of depression. Although rapid weight loss has been shown to reduce depression temporarily it needs to be re-evaluated frequently.
Untreated depression is the most common psychological condition associated with relapse following successful weight loss. Often it worsens as people face the weight loss maintenance phase and greater temptations from food. Occasionally it occurs after weight loss when a clash of expectations and reality set in among those who felt weight loss would change the world around them or how they are treated at work or at home. However, this is less common. Treatment of depression is effective in preventing weight regain but must be integrated into a comprehensive effort at maintaining a healthier weight including exercise, diet medications and long-term follow-up and record keeping.
Diagnosing Depression
Depression and other mental health issues are no more common in overweight individuals than the general population. They are common in both groups. For many years depression was ignored either because it was wrongly considered a character flaw or because the treatments for depression were difficult to use. Currently nothing could be farther from the truth. Depression is a neuro-biological disease and its treatments are often simple and very effective in primary care.
In one recent study of adolescents, current depression predicted future obesity. Additionally current depression predicts greater problems with future weight control. Hence it is clear that depression cannot be ignored in a comprehensive weight control program. How can you tell if you are suffering from depression?
The key diagnostic symptoms of major depressive disorder are 1) depressed mood and 2) loss of interest in usual pleasures. Depressed mood may be one or more of the following: persistent sadness, anxiety, hopelessness, pessimism, guilt, worthlessness, and helplessness. Loss of interest or pleasures in hobbies and activities you once enjoyed includes sex. Additionally insomnia, particularly early-morning awakening, or oversleeping is common with depression. Changes in appetite with weight loss or weight gain is a symptom as is decreased energy, fatigue, particularly feeling “slowed down”. Restlessness, irritability, difficulty concentrating or remembering and difficulty with decisions are potentially depression symptoms. Sometimes physical symptoms that do not respond to treatment including headaches, digestive disorders and chronic pain are depression symptoms. The most dangerous depression symptom is suicidal thoughts or plans for death. While few people with depression commit suicide it remains a symptom that often requires hospitalization. Fortunately suicidal thinking often passes after 72 hours.
Obviously these symptoms are common in every-day life. How do you know when they are serious enough to consider the diagnosis of depression? To be a factor in diagnosing depression five or more of these symptoms must be present and interfere with day to day life for at least two weeks. If this includes you, consider discussing depression with your doctor as soon as possible. Treatment is safe and effective. Other forms of depression exist such as bi-polar disorder (also known as manic depression) and dysthymia. These diseases have some similarities with major depressive disorder (depression) but also significant differences. If you feel you may be depressed discuss this with your doctor.
Treatment for Depression
The first step in depression treatment is to realize that it is a treatable medical disease. Depression is a complicated neuro-chemical imbalance in the brain triggered by emotional events in patients vulnerable because of previous depressions or family history or both. Once the diagnosis is made, therapy, medications and lifestyle changes can help control depression. Treatment causes depression to remit within days to a few weeks and continues to be effective as long as it is used. Primary care physicians treat most depression.
Over the last 15 years a number of new medications have revolutionized depression treatment. Until Prozac was released the standard antidepressants had a large number of potential side effects and required skillful dosage adjustments. Prozac became a standard soon followed by other drugs called selective seritonin reuptake inhibitors (SSRIs). These drugs worked in 80% of patients within three weeks with minimal side effects in most cases. Most patients are treated for 6 to 9 months for their first depression episode and longer for their second or subsequent depression.
Some critics of antidepressant treatment label it “cosmetic psychopharmacology”. The truth is far different. Modern antidepressant treatment has reduced illness and improved quality of life in ways not seen since antibiotics became common after World War II. Not only have millions with depression felt their black mood lift, but also their burden of medical illness has lessened and they have been able to return to full and healthy lives.
If you feel depression is an issue for you see your physician soon and describe your symptoms and how they are affecting your day-to-day life. Treatment with medications and counseling in some cases is now considered the standard of care and is more effective than treatment for other diseases like high blood pressure. Expect to see your doctor in follow-up for medication adjustment and don’t terminate treatment too soon or you face an increased risk of relapse.
For patients working on weight control depression treatment may turn a hopeless battle into victory. Some antidepressants can cause weight gain and you may seek alternatives like Buproprion (Wellbutrin) that are weight neutral or associated with weight loss. Ask your doctor and he or she can help you see that depression never becomes a barrier to life-long weight control.
Counseling for Depression
Psychotherapy, called the “talking cure”, has been a professional technique for depression and other mental illnesses for over 100 years. While there are several established techniques used in therapy, all can be effective. Often several sessions are used to gather history and assess the impact of depression and further sessions are used to build understand and skills that can relieve depression. Each session is typically 60 minutes and therapists ask questions designed to better understand the situation and how it can be improved. Therapists rarely provide direct answers; it is critical to success for the counselor to enable the patient to discover the answers themselves.
Psychotherapy is most commonly used in depression and other anxiety disorders. It is particularly helpful when significant life stressors or events need to be analysized and better understood for long-term mental health. Often psychotherapy and antidepressant medications are used together. Medications can lift the emotional symptoms and therapy can help rebuild confidence and self-esteem. Modern psychotherapy is usually goal-directed and time-limited over a 3 to 6 month period using 12 sessions. If you feel counseling would help you face depression discuss this with your doctor.
Bereavement versus Depression
Loss is a sad and common circumstance. A mother’s death, a child’s tragic accident, a divorce, a layoff at work are among the most dramatic stressors anyone will face and depression symptoms, often called bereavement, are inevitable. Bereavement is a normal and healthy stage following loss with it’s own cycle of denial, anger, bargaining, depression and acceptance according to the behavioral experts. Loss is a common trigger for stress eating and in many cases passes as the worst of the symptoms pass with the healing effect of time.
Bereavement can be followed by serious depression that can require intervention and treatment. After an initial period of shock most people slowly resume normal activities intermixed with sadness lasting up to a year. If there isn’t a recovery over time depression must be considered and should be treated with the goal of returning normal function. Just when and how this should be determined is best done by your doctor. Just as depression can stall your weight loss program, unremitting bereavement can also be a barrier to a healthy weight and can be addressed by treatment.
This series of articles was originally published in a broadcasts of the Health-e-Thoughts Newsletter (distributed by betterMD.net in three installments, October 16 through October 31, 2002)[/fusion_text][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]
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