Weight problems and depression
Whilst either weight loss or gain can be a symptom of depression, many sufferers find that the problems of excess weight add to the difficulties they are already facing. Many factors combine to make weight loss incredibly challenging for the depressed person, and act together to make things more difficult than ever.
Energy and Motivation
Depression sufferers feel constant tiredness, which can be aggravated by broken sleep patterns. Total exhaustion is a key indicator of depression, as is a feeling of hopelessness: why bother, when anything you attempt is likely to be overwhelmingly challenging to achieve anyway. Losing weight through diet and exercise takes considerable energy and effort over a period of time, which can be impossible for a depressed person to consider. A severely depressed person cannot effectively look to the future and envisage a healthier slimmer person, or how it would feel to be that person. They are trapped in helpnessness and passivity, and often feel they have no influence on the wider world, no sense of control.
The Body and the Self
Depression can be linked to a psychological trauma, and in this case carrying extra weight can be a physical expression of an inner hurt, a literal defensive layer between their self and the world, to help hide fear and vulnerability. If someone has been sexually exploited or assaulted, they may allow themselves to become overweight and unattractive for this reason - because on some level they blame themselves for what was done to them. Depressed people characteristically attribute bad things happening to themselves, something they said or did to make it happen (whereas good things get attributed to external factors like luck or chance)
Deciding to lose weight is ultimately an act of self-love that can be impossible for a depressed person to consider, when they cannot easily visualise the benefits it would bring. Feelings of low self-worth are so common in depression, a sufferer might feel they don't deserve to be slender and healthy. Holding on to excess weight is actually a kind of self-harm, punishing the 'you' that you feel held back or let down by, undeserving of being happy or attractive.
Comfort of Eating
Some people overeat when depressed in search of the emotional support life is not currently offering... especially if they previously enjoyed food and took pleasure from it, it's that pleasure they are still hungry for, and not finding - so the search continues. Eating a heavy meal can cause a genuine physical numbness, which temporarily suppresses sadness and other emotional feelings, literally quieting a racing mind as the blood supply is diverted to a major digestion task. And the eating itself can be a distraction or displacement activity, especially if for someone who is both anxious and depressed.
Many people are drawn to sweet tastes for comfort - this is biologically our first taste, as a nursing infant, and it is usually culturally reinforced with every sweet treat offered as a reward throughout childhood. Indeed simple carbohydrates (sugars) do temporarily raise the blood sugar... but then it crashes horribly as the insulin spikes in response, leaving a greater depression and associated sugar craving.
Depression and activity levels
Even if someone had an active lifestyle before becoming depressed, the likelihood is that they will now be burning very little energy through exercise. Finding less enjoyment in life generally, the social and physical rewards of exercise are not sufficient motivation at this time, and severely depressed people often sink into a trance-like state that is metabolically barely distinguishable from sleep. Depression causes feelings of tremendous inertia - the weight of the world pressing down. And starting any kind of exercise program means envisaging a better, changed, future, along with a sense of control of one's future - all of which can be simply beyond the reach of a depressed person.
A further bitter irony for the depressed person is that the medication they are prescribed to treat their mood disorder may also be making them gain weight.
As depression is a life-threatening condition, this may have to be viewed as the price to pay - but typical antidepressants can have hormonal affects on the appetite, as well as suppressing the basal metabolic rate. These effects might be tiny, but they are incremental, and antidepressant medications are often taken over very long periods to be most effective.
The Good News
Because depression and weight gain are so intimately linked, they can be tackled simultaneously. Once one starts to improve, the other often follows rapidly and is easier to deal with, an small steps matter. Setting small, realistic goals, such as a short daily walk, can pay big dividends. Once depression is being treated, it's easier to offset the potential weight gain from medication by doing little exercise, and becoming motivated to eat more healthily. The results for both areas create positive feedback for each other, and speed of improvement can easily be built up.