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In my private psychotherapy practice, as well as the TMS treatment component, many of my patients struggle to achieve or maintain a healthy body weight. Studies on weight loss and obesity reveal a disturbing trend toward a ‘thinness bias’ – in the media and our public health system. A woman whose waist measures more than 35 inches and a man whose waist measures more than 40 inches may be at particular risk for developing health problems.
It is discouraging for my patients to realize that many drugs prescribed for high blood pressure, diabetes and depression – conditions common to individuals with overweight issues – may increase the likelihood of more weight gain, and set in motion a very frustrating circle.
A 2010 study found that people with depression were at a 58% greater risk of becoming obese (30-39.9 BMI). Major depressive disorder (MDD) can be a chronic condition involving recurrent episodes throughout a patient’s life.
Other Studies have found that antidepressants lead to increased body weight, in anywhere between 24-100% of patients. Many patients choose to discontinue antidepressant medication due to the long term side effects resulting from these drugs – one of which is consistent weight gain over time. Among the antidepressants most strongly linked to clinically significant weight gain (defined as at least a 7 percent increase in body weight), include older tricyclic antidepressants, such as amitriptyline (Elavil) and nortriptyline (Pamelor), as well as newer medications, such as paroxetine (Paxil) and phenelzine (Nardil). The antidepressant mirtazapine (Remeron) is so potent at promoting weight gain that it is sometimes prescribed to underweight senior adults and AIDS patients.
Second-generation antipsychotic drugs, such as olanzapine (Zyprexa) and Clozapine (clozaril), can induce a triad of symptoms – dramatic weight gain, diabetes and elevated blood cholesterol levels – that are associated with metabolic syndrome.
In every age group, women with depression were more likely to be obese than women without depression. The proportion of adults with obesity rose as the severity of depressive symptoms increased.
Fifty-five percent of adults who were taking antidepressant medication, but still reported moderate to severe depressive symptoms, were obese.
Understanding the relationship between depression (defined by moderate to severe symptoms) and antidepressant usage and obesity may indicate treatment and prevention strategies for both conditions.
More than one-half of adults with moderate to severe depressive symptoms, who were also taking antidepressant medication, were obese. Among adults who took antidepressant medication, of those with moderate or severe depressive symptoms, 55% were obese while 38% with mild or no depressive symptoms were obese (Figure 5). Among adults not taking antidepressant medication, 39% of adults with moderate or severe depressive symptoms were obese compared with 33% of adults with mild or no depressive symptoms.
Adults who took antidepressant medication were more likely to be obese than those not taking antidepressants.
While the physical health costs of obesity have become increasingly clear, the existence and nature of a relationship between obesity and mental health in the general population has been less clear. The unfavorable effect of depression on development of obesity, and the effect of obesity on development of depression, may be reinforced by time.
Obesity can be seen as an inflammatory state, as weight gain has been shown to activate inflammatory pathways and inflammation in turn has been associated with depression. Also, the hypothalamic-pituitary-adrenal axis (HPA axis) might play a role, because obesity might involve HPA-axis dysregulation and HPA-axis dysregulation is well known to be involved in depression. Through HPA-axis dysregulation, obesity might cause development of depression. Finally, obesity involves increased risks of diabetes mellitus and increased insulin resistance, which could induce alterations in the brain and increase the risk of depression. Being overweight and the perception of overweight increases psychological distress. In both the United States and Europe, thinness is considered a beauty ideal, and partly because of social acceptance and sociocultural factors, obesity may increase body dissatisfaction and decrease self-esteem, which are risk factors for depression.
Disturbed eating patterns and eating disorders, as well as experiencing physical pain as a direct consequence of obesity, are also known to increase the risk of depression.
In Part 2 we will consider these findings, and discuss ‘Implications for Patient Treatment’.
Hear what Nashville TMS patients have to say about their depression treatment experiences and outcomes! For more information on this and other topics related to the treatment of depression and mental health issues, contact us at (615) 327-4877.
Last updated: 23 Dec 2015Views expressed are those solely of the writer and have not been reviewed.
There is a growing body of literature on comorbid depression and diabetes, and this article highlights major findings to date in terms of prevalence, etiology, screening, diagnosis, and treatment. There is increasing evidence that there is a strong association between diabetes and depression[4-16]; however, the etiological basis of the relationship is not known.
Depression typically precedes the development of type 2 diabetes in 90% of cases by many years,[17] suggesting depression may lead to diabetes. It has also been suggested that psychosocial factors associated with diabetes, specifically a patient's perception of the impact of diabetes on overall health, may lead to the development of depression. The relationship between depression and diabetes is clearly complex and is most likely attributable to many factors. Depression has an enormous impact on many aspects of care in diabetes, including self-management, health outcomes, and quality of life. Depression and diabetes is also associated with an increased risk of microvascular and macrovascular complications. Individuals with depression and diabetes have greater functional disability compared with those with diabetes or depression alone. As well, symptoms cause clinically significant distress or impaired functioning (eg, social or occupation). Regardless of the screening instrument used, a diagnosis of depression must be confirmed by additional testing. The benefits of treatment for depression extend beyond improved mood and can include improved sleep and eating habits, increased activity (physical activity, productivity at work, and social interaction), improved coping skills and overall functioning, pain relief, and improved pain tolerance.
In a randomized, double-blind, placebo-controlled trial, fluoxetine was found to reduce the severity of depression compared with placebo over an 8-week period in patients with diabetes (N = 60).

Although these studies show pharmacotherapy and CBT can be effective in the treatment of depression in diabetes, larger, long-term studies are needed to provide further information on the effect of treatment, both pharmacotherapy and psychotherapy, on clinical outcomes in depression and diabetes. The beneficial effects of physical activity on overall health and well-being are well-established. The beneficial effects of physical activity may extend to the alleviation of depressive symptoms, an area of active research over the past several decades. Lustman PJ, Griffith LS, Clouse RE, Freedland KE, Eisen SA, Rubin EH, Carney RM, McGill JB. Katon WJ, Von Korff M, Lin EH, Simon G, Ludman E, Russo J, Ciechanowski P, Walker E, Bush T.
Williams JW Jr, Katon W, Lin EH, Noel PH, Worchel J, Cornell J, Harpole L, Fultz BA, Hunkeler E, Mika VS, Unutzer J; IMPACT Investigators. If you have diabetes, you have a higher risk of depression compared to people who don’t have diabetes.
If you’ve been feeling sad, blue or down for more than a few days at a time, it’s important to seek professional help. No specific food will cure depression, but making healthy food choices might help ease some of the symptoms. Amy Campbell MS, RD, LDN, CDE is an experienced health, nutrition and diabetes educator and communicator with more than 25 years of experience within the healthcare sector.
Instantly download 5 Healthy Diabetes Recipe e-books and the “Costco Heart-Healthy Shopping Guide” eBook! Depression typically strikes people in the prime of their lives, between 25-44 years old, although it can occur at any age.
Before reading the symptoms, please, if you or someone you know is suspected of being depressed, please seek help with your doctor or healthcare provider. Being depressed is serious for everyone; however having both diabetes and depression does create unique and special problems.
Diabetes and depression can also cause you to not want to exercise, another key treatment component. Hopefully, the takeaway from this article is that you know that depression and diabetes is very common.
KEY POINTS People living with diabetes who also have untreated depression are at increased risk of death.
More than 42,000 patients with type 1 or type 2 diabetes and depression were analyzed in the review. Please note: CFAH reserves the right to moderate all comments posted to the Health Behavior News Service. For questions regarding CFAH operations prior to January 1, 2015 contact Dorothy Jeffress, former CFAH Executive Director. They tell me about their frustrating efforts with the latest weight loss plan or supplement, even though they report that they’ve “tried just about everything”. The struggle to be thin is fast becoming the cause of drastic eating disorders and other serious psychological problems among both overweight and non-overweight individuals. 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).
In order to reduce the chance of relapse, long term treatment with antidepressants is often deemed necessary.
Because inflammation plays a role in both obesity and depression, inflammation could be the mediator of the association.
Our goal is to offer patients alternative  treatment options that break this Vicious Cycle. West brought the technology of NeuroStar TMS to Nashville, becoming the first physician in Tennessee to offer the option of Transcranial Magnetic Stimulation for patients whose severe depression has not responded to a course of antidepressant medication or treatment for depression. Whether depression leads to diabetes, diabetes leads to depression, or the association between the two conditions is related to some unknown third variable is not known.
Metabolic changes associated with depression (eg, hyperglycemia) or poor self-care behaviors (eg, physical inactivity, poor diet, or smoking) could contribute to the development of diabetes.
The elucidation of these factors is important to help identify patients susceptible to comorbid depression and diabetes. Finally, symptoms are not attributable to another factor (such as medication, a drug of abuse, a general medical condition, or bereavement). All subjects participated in an individual, 1-hour, biweekly diabetes education program with a diabetes educator. In diabetes in particular, physical activity can have substantial health benefits in terms of improved glycemic control, improved cardiovascular outcomes (ie, hypertension, hyperlipidemia, and cardiovascular disease), and in weight loss and weight maintenance. In both studies, patients in the intervention arm showed greater improvement in depressive symptoms than those receiving usual care after 1 year, although there was no difference between study groups in terms of diabetes-specific outcomes.
Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes.
Independent factors associated with major depressive disorder in a national sample of individuals with diabetes. Non-insulin-dependent diabetes mellitus is associated with a greater prevalence of depression in the elderly.
Burden of illness, metabolic control, and complications in relation to depressive symptoms in IDDM patients.
Lifetime prevalence of major depression and its effect on treatment outcome in obese type II diabetic patients.
Psychological status among elderly people with chronic diseases: does type of disease play a part? Addressing the needs of patients with multiple chronic illnesses: the case of diabetes and depression. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs.

Relationship of depression and diabetes self-care, medication adherence, and preventive care. The relationship of depressive symptoms to symptom reporting, self-care and glucose control in diabetes. Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care. Screening for depression across the lifespan: a review of measures for use in primary care settings. The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. The structured clinical interview for DSM-III-R personality disorders (SCID-II), part I: description.
Nonpsychiatric physicians' identification and treatment of depression in patients with diabetes.
Fluoxetine for depression in diabetes: a randomized double-blind placebo-controlled trial. Effects of nortriptyline on depression and glycemic control in diabetes: results of a double-blind, placebo-controlled trial. The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. The effectiveness of depression care management on diabetes-related outcomes in older patients. While researchers aren’t exactly sure why this is, living with and managing a chronic condition every day can be stressful and can take its toll.
Depression can be effectively treated and managed in a number of ways, including with therapy or medication. Eat broccoli, asparagus, spinach, avocado, eggs or fortified cereals to get your daily dose of folate.
Eating carbohydrate foods can stimulate the production of serotonin, a brain chemical that can make you feel good.
Depression can make diabetes self-care more difficult and lead to complications from the disease. The reviewers discovered that depression was associated with a 1.5 fold increase in the risk of dying. Because depression can make diabetes self-care more difficult and lessen quality of life, she suggested that depression treatment should be included in overall diabetes care strategies.
When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required.
Depression and risk of mortality in individuals with diabetes: a meta-analysis and systematic review. All users agree not to claim, infer, or imply GW endorsement of the user’s activities. For information on obtaining a commercial use license, please contact the George Washington University Office of Technology Transfer. This weight gain is especially troublesome as it also heightens a person’s risk of physical problems, such as diabetes and cardiovascular disease. So we clearly see how that could easily translate into a weight gain of 72 pounds or more over two years. However, a longitudinal meta-analysis confirms a reciprocal association between obesity and depression in both men and women. With TMS, we can start them on the path to improved health, both physically and psychologically. The Nashville TMS Team has treated patients from Tennessee, Kentucky, Colorado, California, Missouri, New York, Florida, and Alabama.
Potential causative factors, whether genetic, biological, psychological, or psychosocial, are also largely unknown. A framework showing the complex relationship between depression and diabetes outcomes has been developed based on an extensive review of the literature. In total, 70.0% of patients who received CBT achieved remission of depressive symptoms compared with 33% who did not receive CBT.
In addition, you might feel alone and different from other people, and you might be worried about complications from your diabetes. In four of the studies reviewed, co-morbid depression was linked to about a 20 percent higher risk of cardiovascular death for people with diabetes. While the information provided in this news story is from the latest peer-reviewed research, it is not intended to provide medical advice or treatment recommendations. Supported by the Jessie Gruman Memorial Fund, cfah.org resources will remain online until January 2020. Additionally, overweight and obese individuals are at risk for numerous psychological and physiological health problems, such as depression and disordered eating. Food sources for omega-3’s include fatty fish (like salmon and tuna), flaxseed, canola oil, walnuts and pumpkin seeds. This “sunshine” vitamin is also found in fatty fish (including salmon and sardines), milk and yogurt fortified with vitamin D, egg yolks, liver and cheese. Almost 11% of adults take antidepressant medications, including persons who are responding well and persons who still have moderate to severe symptoms of depression.

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