Talk therapy
I believe in combination therapy for the treatment of depression: combining medication therapy with psychotherapy. Depression is a vicious cycle of a biochemical imbalance and destructive or unproductive behavior/thought patterns. Many experts agree that psychotherapy is a powerful tool for helping depressed patients explore core thought processes and behaviors that can exacerbate the depression.
Medication is often necessary to overcome the chemical imbalances in depression. Managing psychological reactions to external triggers that occur through the day can only help with the recovery process. Even the most analytical individual may not always step back from the situation and look at what is happening objectively. I went through the phase of “if I were so smart, I can talk myself through it.” Then, I meet a mental “wall” in the face of an emotional or environmental trigger. Even as I consciously knew that I was repeating a pattern, I felt powerless to overcome the reactionary behavior. Psychotherapy helps trip my old behavioral wires so I can establish new, productive coping skills.
Cry. it’s good for you!I see the medication therapy as giving me a window of opportunity so that what I have learned from talk therapy can “sink in and take lasting effect”. Medication had gotten me out of bed to be functional (this is especially critical for severely depressed patients who could not imagine life beyond the next minute). Psychotherapy helped me gain insight into conditioned patterns of thinking. This helped me manage unproductive emotional reactions before I became overwhelmed.
Finally, it is helpful to look at therapy as Dr. Alan Siegel at Cambridge Hospital in Boston puts it: “It is hard to resolve depression without tears.”
I need a new wardrobe with my medication
Aside from sexual dysfunction, weight gain is another side effect that becomes problematic for patients who need long-term antidepressant therapy. Many patients stop antidepressant therapy on their own, without notifying the physician (”noncompliance”) due to undesirable side effects that further impact their self image or normal daily functioning.
Most Psychotropics Cause Weight Gain
The effects of antidepressant therapy on weight, particularly those within the SSRI (selective serotonin reuptake inhibitors, such as fluoxetine, sertraline, paroxetine, or citalopram) class, have been often debated. Often, early during treatment, SSRI’s have been associated with weight loss due to increased agitation in some patients. However, in the long run, the patient may gain weight due to mechanisms that are still not well understood. Atypical antidepressants such as nefazodone (brand name Serzone) and bupropion (brand name Wellbutrin) are not associated with weight gain, although bupropion appeared to be linked with weight loss. The atypical antidepressant mirtazapine (brand name Remeron) is associated with significant weight gain, which may be an advantage for elderly patients who are often dangerously underweight.
Weight gain may also be a “natural” part of recovering from depression. If a patient loses appetite due to depression and stops eating, recovery will include a desire to eat and therefore regaining of lost weight. Some antidepressants may change appetites or metabolism, and these mechanisms warrant further study.
Many have complained of cravings certain foods (such as carbohydrates) while on antidepressant therapy or mood stabilizers. While patients may not stop therapy due to weight gain, clinicians are beginning to realize that weight gain is not simply a cosmetic issue. Patients who gain a large amount of weight may be less likely to keep complying with therapy (keep taking medication as directed) and their self image will not improve. Recently, weight gain associated with medication therapy had taken on a more insidious nature - accompanied by increased risk for heart disease or diabetes.
Although new drugs in the pipeline for treating depression and mood disorders may have improved side effect profiles and minimize weight gain, for the time being, physicians do not have a many options for treating weight gain cause by medication therapy, other than changing medications or stopping the medication therapy.
Psychological v. Physiological Craving
With my own treatment-induced weight gain experience, my cravings weren’t due to hunger. I would often be full, and still crave sweets. Gorging on sweets was comforting. It was easy to lose control with a gallon of ice cream or a whole pizza pie. I saw this as a psychological side effect rather than being hungry. Since people react to medications differently, what made me gain weight may easily make someone else lose too much weight. Therefore, even testing medications that will help your symptoms improve without too many side effects remains an individual trial and error.
I have been free of antidepressant therapy for many years. I was able to take off most of the extra weight through good old fashioned “eating smaller portions” and exercise. I still have carbohydrate cravings - these seemed to not go away. However, a high protein, low carbohydrate diet seemed to help take the edge off the cravings.
In addition, I also get adequate sleep. Studies have shown that lacking sleep can actually contribute to weight gain and obesity, plus other health problems associated with sleep deprivation.
Drinking water and keeping yourself hydrated throughout the day is a simple yet important way to keep your body working properly.
Incorporating weight- or resistance training with regular aerobic exercise is an excellent method to increase metabolism. Muscles require energy and you are able to burn fat even while not aerobically exercising. For women, please do not worry about “buffing up” too much. Unless you were genetically programmed for bulk, regular weight training will tone muscle, not build bulk.
Finally, when the cravings are clearly psychological - when you’re bored, when you’re stressed - keep a list of things to do to distract you from your cravings, or simply remove yourself with a walk down the block or in the park.
I know these aren’t clear-cut solutions, especially if you are still on an antidepressant for managing your depression. Trying many different methods - especially non-medication methods - can maximize your chances of controlling treatment-related weight gain.
Bipolar Disorder Spectrum
If you think that Bipolar Disorder can be classified simply as a condition with extreme highs and lows - you are correct - to a certain extent. The presentation at the 153rd APA meeting (May 2000) by highly respected BP researcher Dr. Hagop Akiskal delved into “The Spectrum of Bipolarity”. Diagnoses within the DSM-IV and ICD-10 criteria for manic depression now expand to include Schneider-positive psychotic forms (often expressed during the manic phases), bipolar mixed states, and rapid-cycling states.
In General
Bipolar disorder type I (BP-I) is defined as those with extremes of mania and depression.
Bipolar disorder type II (BP-II) experience hypomania (not as severe as mania) rather than classic mania.
Bipolar disorder type III (BP-III) is defined as those who were depressed and became hypomanic due to antidepressant medication therapy.
Patients with Bipolar disorder type IV (BP-IV) experience cycles of depression and “hyperthymia”. Hyperthermia differs from hypomania as follows: in hypomania, the person’s high energy level is unlike the “usual” trait of that person. In hyperthymia, the person is being his or her usual cheerful self.
BP I to IV According to Akiskal
* BP-I Extremes of mania and depression
* BP-II Hypomania rather than classic mania
* BP-III Depressed and became hypomanic due to antidepressant medication therapy
* BP-IV Cycles of depression and “hyperthymia”
Not wanting to confuse you more (but I’ll have to), I’ve found yet another set of classification for bipolar disorder:
BP I to VI According to Klerman (1928-1992)
* Type I Mania and Depression
* Type II Hypomania and Depression
* Type III Cyclothymia
* Type IV Hypomania or mania precipitated by medication (particularly antidepressants)
* Type V Depressed patients with Bipolar relatives
* Type VI Mania without Depression
The inclusion of the spectrum of “softer expressions” of mania within the depression diagnoses bumped the prevalence of bipolar disorder from 1% in the U.S. to 5%. Even though I understood what I was reading, I admit to getting confused with the many variations of bipolar disorder. This underscores how important it is for patients to be proactive in communicating their symptoms to their physicians!
It is extremely critical that you make a list of symptoms which do not fall within the “normal” range of activities or behavior before you see the doctor. Don’t lock yourself into a label of a particular type of disorder by self-diagnosing. The majority of diagnoses for mental disorders happen within a primary care setting (general practitioners). This means you are seeing physicians who may not be fully equipped to recognize the subtle variations of a depressive disorder you may be suffering from. Help the physician help you by creating a list of symptoms and communicating this to the physician.