The Vicious Cycle
In Part 1 of 2, we curated and reviewed study findings that focused on the question:
“Does overweight and obesity increase the risk of developing depression,
or does depression increase the risk of developing overweight and obesity?”
We discussed a few of the observations in Part 1:
- More than two-thirds of American adults are overweight or obese, according to the Centers for Disease Control and Prevention.
- More than one-half of adults with moderate to severe depressive symptoms, who were also taking antidepressant medication, were obese.
- Americans weigh more today than ever before. And they are getting heavier every year.
- Weight Loss is a National Obsession!
- Studies indicate that increased abdominal or upper body fat is related to the risk of developing heart disease, diabetes, high blood pressure, gallbladder disease, stroke, and certain cancers; and is associated with overall increases in mortality (likelihood of death).
- Many drugs prescribed for high blood pressure, diabetes and depression – conditions common to individuals with overweight issues – increase the likelihood of more weight gain, and set in motion a Vicious Cycle.
Depressive Symptoms and Obesity
Now in Part 2, we take a deeper dive into the findings of these studies. Forty-three percent of adults with depression were obese, as compared with 33% of adults without depression. Women with depression were more likely to be obese than women without depression. And these relationships were consistent across all age groups among women and was also seen in men aged 60 and over.
Researchers conclude a ‘bidirectional relationship’; meaning that obesity increases the risk of depression and depression increases the risk of obesity:
- As the severity of depression increases, the percentage of all adults and of women with obesity increases as well.
- Both moderate to severe depressive symptoms and antidepressant use were associated with increased obesity.
This bi-directional association between depression and obesity was also quantified:
- obese persons had a 55% increased risk of developing depression over time, whereas
- depressed persons had a 58% increased risk of becoming obese.
Depressive Symptoms and Antidepressant Medications
Moderate to severe depressive symptoms were associated with a higher rate of obesity both in persons who were taking antidepressant medication and those who were not, and antidepressant use was associated with a higher rate of obesity in persons with moderate to severe depressive symptoms and those with mild or no depressive symptoms.
Of all the categories, the highest prevalence of obesity (54.6%) was found in persons who had moderate or severe depressive symptoms and took antidepressant medication.
Planning Prevention and Treatment
Knowledge of these risks may help patients, general medical practitioners and mental health professionals plan prevention and treatment.
Given this set of findings, we want to discuss an exciting opportunity to break the Vicious Cycle – through a combination of treatments that address symptoms related to obesity and depression. This includes Transcranial Magnetic Stimulation (TMS), a proven, non-medication approach to treatment-resistant depression.
Implications for Patient Treatment
Evidence suggests that patients with mental disorders often do not receive adequate care for their medical illnesses, highlighting the need for increased awareness of, and attention to, the physical health problems of individuals with mental disorders – including depression. In particular, the metabolic and weight issues resulting from antipsychotic treatments require appropriate management.
In overweight or obese patients, mood should be monitored. This awareness could lead to prevention, early detection, and co-treatment for those at risk, which could ultimately reduce the burden of both conditions.
Alternatively, antidepressant medication-induced weight gain can be detrimental to a patient’s physical health and recovery process. To address this issue, a holistic, multidisciplinary approach to treatment is recommended. It is critical that clinicians take precautions to monitor and control weight gain and to treat all problems facing a patient.
Vigilance in Management and Prevention
The best way forward in management and prevention is to be vigilant from the very beginning. Specific measures are required in the clinical practice of psychopharmacology to deal with weight gain and related issues:
- Thorough baseline assessment of family history, risk factors, health psychology, life style and dietary habits.
- Monitor weight and metabolic parameters closely throughout the course of treatment.
- Work with a meaningful multidisciplinary team to target all vulnerable areas.
- Incorporate behavioral intervention programs.
- Involve dieticians to monitor nutritional requirement.
- Avoid polypharmacy as much as possible.
- Attempt to treat weight-gain with behavioral and pharmacological measures.
- Treat metabolic conditions, like hyperlipidemia and diabetes.
- Obtain good control over hypertension.
- Obtain adequate remission of depressive and negative symptoms.
Transcranial Magnetic Stimulation
Many of my patients who become aware of the benefits of TMS (Transcranial Magnetic Stimulation) are already on a course of antidepressant medication before they start TMS treatment. And a great many of them have tried different classes of antidepressants over the years. One of their first questions is, “Do I have to go off my antidepressant?”
The answer to their question is a resounding, “No.” We treat each patient on an individual basis. When they start responding to their TMS treatment, we discuss how they feel, and whether or not they may be ready to start to wean off the antidepressant. It is definitely not required. Some patients do well and want to wean immediately, while others like to stay on their meds for a time, and wean more slowly – if at all.
About TMS – Non-Pharmaceutical Treatment of Depression
TMS is a no drug treatment for depression that takes less than an hour a day. TMS Therapy has been proven safe and effective in the treatment of depression.
TMS Therapy is an FDA-cleared non-invasive medical treatment for patients with major depression who have not benefited from antidepressant medication. It is precisely targeted at a key area of the brain known to be underactive in depression sufferers. NeuroStar uses highly focused magnetic pulses to stimulate that area to restore it to normal function and lift depression.
- TMS Therapy is free of side effects typically experienced with antidepressant medications. The most common side effect associated with treatment is discomfort at or near the treatment area – generally mild to moderate.
- Each TMS treatment takes less than an hour and is conducted in your doctor’s office, five days a week, for approximately four to six weeks.
- Patients are awake and alert during treatment and are able to resume normal activities upon leaving the treatment sessions.
Help and Hope
Talk with your doctors and your pharmacist. They are likely able to suggest either alternative treatments for depression (such as TMS), without the side effects of antidepressant medications; weight-neutral alternative drugs; and/or lifestyle choices. In combination, they go a long way to counter the effects of overweight, high blood pressure, diabetes and depression – and foster life-changing improvements in mental and physical well-being.
Wide Effect: Drugs That Promote Weight Gain
Weight-Gain in Psychiatric Treatment: Risks, Implications, and Strategies for Prevention and Management
The prevalence of obesity is increasing at an alarming rate.
Obesity and Mental Disorders in the General Population: Results
from the World Mental Health Surveys
To investigate an association between obesity and mental disorders
Depression and Obesity in the U.S. Adult Household Population, 2005–2010
What is the definition of Obesity?
Overweight, Obesity, and Depression:
A Systematic Review and Meta-analysis of Longitudinal Studies
Association between obesity and depression has repeatedly been established