Dear DOCTOR Owen:

I have gained 50 pounds over the last five years. I am so depressed that I cannot muster the energy to do anything. I feel lethargic, cry frequently, and want to sleep all the time. When I exercise and diet for a few days, I usually feel better. I have heard that depression causes weight gain. Will treatment for depression also help with weight loss?

Depressed

Dear “Depressed”:

Your situation is the proverbial “chicken or egg.” Does the depression cause the weight gain or does the weight gain cause the depression? Clearly, they are related. A large body of clinical research has been done on this subject. The psychiatrist who works with me at my clinic has developed an assessment scale that attempts to relate these issues. According to my colleague’s scale, many people with serious obesity are depressed and have mood-related eating disorders, trouble with motivation, and strong family histories of the same. Most of them do not have eating disorders that cause over-eating, but, as she puts it, have “disordered eating patterns.”

In “measuring” depression at the clinic, we have found that approximately 50% of patients on antidepressants can eventually discontinue the medication—provided they lose at least 20% of their original weight and burn more than 2000 calories in exercise/week (equivalent to walking 3 miles/day). Other studies show results that are at least as good. One study showed a 73% reduction in depression scores with diet intervention alone.

How can this be? Well, think of “airhead” discussions you hear, or have listened to, about “mind,” “body,” “spirit.” The mind is considered a separate entity from the body and the spirit. Because of its separateness, or detachment, it can operate independently if “willed” to do so. But I believe this is nonsense! The brain is an organ—not unlike other organs in the body. It helps manage the internal organs by sending messages down nerve fibers and through hormones that float through the bloodstream; the internal organs manage the brain by sending impulses back up the nerve fibers and by hormones as well. For example, you eat too much, “feel” like you’re going to pop, and then get sleepy (as my father-in-law would say: “I feel a coma comin’ on”!). Or a hot pecan pie smells “o-o-h so good” that you start to salivate uncontrollably and unconsciously. Your brain, or mind, is the sight, smell, touch, taste, and sound sensor on how the world is interacting with your body.

Here are some frequently observed, obvious, reasons for obesity-related depression:

Excessive weight causes increased levels of insulin, cortisone, adrenaline, and leptin, which decrease the levels of testosterone and growth hormone. These changes, along with countless interactions with brain chemicals, have profound effects on mood and behavior. These hormone disturbances normalize quickly with diet, however. Exercise decreases adrenaline (stress) and increases the production of testosterone, growth hormone, serotonin (a brain chemical), dopamine, and many other chemicals—and has a profound effect on behavior.

• Social ostracism and ridicule.
• Job discrimination.
• Advancement discrimination at school and at work.
• “Nagging” partners, spouses, and other loved ones, work colleagues, and others who profess to be concerned about your health.
• Pain in the joints and spine—sucks down the chemicals of the brain that help with coping and relaxation.
• Sleep apnea—therefore, sleep deprivation (sure depresses me!).
• Medications for diabetes or high blood pressure.
• No wonder you feel like a worthless outcast!

However, an improved biochemical balance, decreased medication, decreased pain, more restful sleep, and the experience of positive weight changes offer much hope, change people’s attitudes, and improve social acceptance. Few things in life are as important to us as acceptance by others. Put into a package, depression diminishes. I strongly advise all depressed patients to actively seek exercise and diet changes whenever possible.

Depression is a chemical disorder of the brain—a serious disorder that can cause suicide. It is often impossible to motivate a depressed person to do anything. Do not assume that diet, weight, and exercise changes will “cure” depression. Antidepressant medications—many of which are being used to treat obese patients suffering from depression—have shown miraculous benefits. Antidepressants help people in weight and exercise programs disspell irrational thoughts so that they can focus on goals, outcomes, and methods of diet and exercise. Meridia®, the new weight-loss drug, was developed as an antidepressant. WellbutrinSR®, Prozac, and other similar agents have also shown some weight-management benefits. They are, in my opinion, part of the equation for improvement that is necessary for good health.

You cannot separate the mind from the body. Do not even try.