Depression

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.

DEPRESSION

Several studies have suggested a link between obesity and depression, especially in women, though it is unclear which comes first. Severe obesity in adults is associated with a five-fold increased risk for major depression, though there have been some conflicting reports. While increased body weight has been associated with major depression, suicide attempts, and suicidal ideation in women, a large Swedish study found a strong inverse association between BMI and suicide in men: for each 5 kg/m2 increase in BMI, the risk of suicide decreased by 15%. In severely obese adolescents,clinically significant levels of depressive symptoms are uncommon, despite global and severe impairment of day-to-day life. On the other hand, children and adolescents with major depressive disorder may be at increased risk of becoming overweight.

Patients with mood disorders may present with a depressed or irritable mood and/or a lack of normal interest in daily life. Depression may also present with the full DSM-IV gamut of symptoms, including change in appetite and weight, motor agitation or retardation, feelings of worthlessness or guilt, decreased ability to make decisions or concentrate, and recurrent thoughts of death and suicide. Yet diagnosing depression may not be as straightforward in obese patients, who can exhibit symptoms as a result of their overall situation rather than organic depression. Many of these patients believe that their mood disorder is a consequence of their obesity and turn to food for comfort.

It is important to address both depression and obesity in the treatment plan. The primary focus should be on managing the depression as depressive anhedonia which, coupled with decreased concentration, can have a significant impact on a patient’s motivation and ability to change lifestyle and behaviour. Inadequately treated depression should probably be considered a relative contraindication to initiating a purely lifestyle-based weight-management effort, as both concentration and organization are required for new habit cultivation.

In certain cases, treating obesity can indeed alleviate depression. It is, however, rare for the treatment of depression to alleviate obesity, and pharmacological treatment of depression may iatrogenically contribute to weight gain. Patients undergoing pharmacologic antidepressant treatment must be counselled on the possibility of weight gain and prophylactic behavioural or medical treatment may be required to prevent the development or exacerbation of obesity. Compared with tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) have much less impact on weight and bupropion has been associated with weight loss. Consideration of obesity in the choice of antidepressant may therefore lead to better adherence to therapy.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

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