Question:
Why do depressed people lose weight? Is it just as a result of reduced
appetite or is there some other mechanism at work? Just wondering as my wife
has just been diagnosed depressed - symptoms include weight loss and
constant fatigue, although she still eats like a horse. Blood test results
were fine.
Answer:
Weight change can be a symptom of depression, as well as a side effect
of most medication. If she has a tendancy to overeat, it might be a
good idea to try a medication that has a side effect of weight loss. Some depressed people gain weight, some lose weight. Depends on how they
view food and eating as a coping mechanism. Nothing "metabolic" about it -
it's all behavioral. How severe is the Depression? Is it situational? I am a member of a depression support group so I have heard lots of
stories from the members about their experiences dealing with depression.
Based upon my experience, it's obvious to me that some depressed people
stop caring about whether they live or die. As a result, they no longer
worry about eating to much or too little. They also eat the wrong types of
food--such as cake and ice cream for breakfast, lunch and dinner. Or--they
might not eat anything for two or three days. You may want to do a google
search on depression. She doesn't believe she is depressed - her only
symptoms are constant fatigue for the last 8 months (to the point of
exhaustion)and this weight loss (around 25lb). Based on this and several
normal standard blood tests (iron, blood cell counts etc.) her doctor has
concluded that no other testing is necessary until she has tried Prozac for
3 months. Her eating habits haven't changed at all. She is a lot less active
now than she was (due to the fatigue) - but I would have thought this would
cause weight gain - not loss. Weight *change* is a common symptom of depression. Some people gain
weight. Medication can affect things too - I gained far too much weight
on one, and it's very difficult to lose it now I'm off it. There isn't a
standard depression. Depends on whether she's also eating less, which wouldn't be
surprising. But why does her doc insist on trying Prozac first? There are a lot
of antidepressants, and Prozac would not necessarily be the best
choice for an individual. If the doc isn't a psychopharmacologist,
I'd like to know the rationale.
(Personally, I wouldn't take Prozac. It destroys your libido. I'd
try something less inhibiting first.)
I agree with you. Depression can be a side effect of a medical
condition and/or medication. Constant fatigue by itself does not constitute depression. It might
conceivably be a condition that would benefit from an antidepressant
medication for reasons unrelated to depression as such, but it
wouldn't be depression. Depression, by definition, has *depressed
mood* as a major defining issue. I can't think of any reason why Prozac would result in her having more
energy, if her lack of energy isn't a side effect of depression. This
doesn't sound right to me.
I would look at endocrine problems first off. You mention a doctor and
"blood tests," but not what kind of doctor. Anemia is an obvious one,
but that's easy to detect, and it sounds like the doctor looked for
it. There are a variety of possible thyroid problems that can cause
fatigue, although the combination of fatigue and weight loss sounds
more like hyperthyroidism than hypothyroidism to me.
How is her sleep? Poor sleep from apnea or other breathing problems
can cause terrible fatigue, though not obviously weight loss.
Hyperthyroidism can also cause poor sleep, and seems to me a more
likely explanation than apnea (though if she sleeps poorly and it
isn't due to hormone problems, then she should visit a sleep clinic
for diagnosis).
I hate to say it, but she might also be a candidate for Chronic
Fatigue Syndrome, although you don't mention any of the other
symptoms.
I would *strongly* suggest that she see an endocrinologist (not a GP)
for a thorough study of her endocrine system. See where that leads
you. If that fails, and she sleeps badly, then visit a sleep clinic.
If she has no endocrine problems and does not have apnea, then a
*stimulating* antidepressant might help with the energy problem, but
that's some ways down the line. I wouldn't want to start there.
But Prozac? That makes no sense to me.
