Q&A Wednesday: Does Depression Come With Weight Loss?

Q: This might be more reflective of my personal journey, however have you ever experienced depression with weight loss. Since I am no longer using food as my medication, upper, filler, friend, I find I have periods of depression and self doubt. Not the kind where I have suicidal thoughts and all, but feelings of sadness nonetheless. Since I have used food most of my life to self medicate not having it leaves me a bit loss. It might just be me and I could use some therapy but this healthy quest for me has come with a dose of depression as well.

A: First and foremost… I am a proponent of therapy. I know there’s a stigma among Blacks in America surrounding therapy, but I will never be that person promoting that ideology, here. If you need to talk to someone, talk to someone who is trained to help individuals develop mechanisms to cope with life.

I’m not surprised to hear that people who change their eating habits might experience some kind of depression in the beginning. In fact, I’m kind of ashamed of the fact that I never brought it up before.

When they talk about food being an addiction and people blow it off… I can’t help but wonder if they know how food relates to the brain and affects our moods. The book The End of Overeating discusses this thoroughly, but I’ll excerpt here:

Eating and the desire to eat need to be understood as separate activities involving separate mechanisms in the brain. Their distinct roles help us understand another brain chemical: dopamine. If opioids give food its pleasure and help keep us eating, dopamine motivates our behavior and impels us toward food. By strengthening our sense of anticipation, dopamine gets us to engage in a complex set of pursuit-and-acquisition behaviors so we can recapture the remembered pleasure of a favored food. Dopamine drives desire through a survival-based capacity known as “attentional bias.” Defined as “the exaggerated amount of attention that is paid to highly rewarding stimuli at the expense of other (neutral) stimuli,” attentional bias allows us to pick out what matters most so we can pursue it. It gives rewarding foods their prominence in our minds. The more rewarding the food, the greater the attention we direct toward it and the more vigorously we pursue it.

Consider the fact that processed foods are engineered to be extremely rewarding – that they are engineered to give us that feeling – when you think about what you’ve been eating. This is why processed foods fuel our ability to be emotional eaters, and why I’m such a proponent of cutting them out via clean eating. Buuuut… let me continue with the excerpting:

Among people who experience conditioned hypereating, emotional states often heighten the power of cues, overpower executive control, and intensify the drive to eat. “It’s a form of self-medication,” said George Koob, at the Salk Institute. “You’re modulating your arousal. People take the food to calm themselves down.” Rajita Sinha, at Yale University’s School of Medicine, said that sadness and anger have the greatest potential to drive a loss of control.

“If you’ve got that really charged emotional situation, with both of these emotions going, chances are you’ll be going to the kitchen before you know it,” she said.

Because a cookie makes me feel better, it’s easy to develop the habit of seeking it out when I’m sad or angry. Over time, as neural pathways link the change in my mood with the experience of eating the cookie, the association grows stronger.

“These products have some kind of hedonic, calming effect,” said Koob. “In other words, they relieve the itch.” The problem is that the itch comes back.

Anger and anxiety can act as a “setting condition” for cues, says Charles O’Brien, a professor at the University of Pennsylvania. “A cue that has been extinguished in the basal state [when the body is calm] again becomes active in producing craving and physiological changes when it is presented after a person has been put in an angry state.”

We see this with smokers. “I can remember being in a room and there was a tense discussion, and everybody would start lighting up, to either increase their alertness or to calm themselves down,” Koob recalled. “I think the same thing happens with people who learn to eat that way.”

The effect is visible in imaging studies in which people undergo brain scans as they respond to cues suggesting they’re about to get a milkshake. In one study, researchers first induced a negative mood by playing some dark music and asking participants to recollect a particularly depressing life experience. Afterward, the regions of the brain where the reward pathways operate showed greater activity level in response to the anticipated milkshake compared with levels among participants in a neutral mood.

“We interpreted those findings as suggesting that when emotional eaters are in a negative mood, the idea that they are about to get a milkshake makes them anticipate reward,” said Eric Stice, a scientist at the Oregon Research Institute. “That’s not the case for non-emotional eaters, and it is not the case for a neutral mood state. It only emerged in a negative mood state.”

When emotions amplify reward, the drive for reward becomes even harder to control.

Stress also lends more power to each of the mechanisms that drive overeating through its capacity to heighten our arousal. “If you’re in an agitated state, a stimulus will act on you more, will generate a little more vigor,” said Bernard Balleine.

Call it the paper-clip-on-the-rat’s-tail phenomenon. Pinching the animal’s tail with a paper clip is a mild stressor-not so strong as to interfere with the animal’s behavior, but strong enough to intensify all its usual activities.

There are limits to the arousing effect of stress. Profound stress-the death of a family member, for example-can interfere with this response and shut down overeating behavior. To capture the impact of mild stress, Balleine suggested I visualize myself in a familiar conference room. When the tone of a meeting is relaxed, Balleine said, “You’re looking around, recognizing cues, but they are not having any motor effects on you.” Then the dynamic of the meeting changes, and someone makes me angry. Suddenly a cue in the room that has signaled reward in the past takes on new power.

For me, that cue is likely to be the platter of cookies sitting in the middle of the table. Under normal circumstances, I probably found its attention-grabbing effect hard enough to resist. Most likely, I was consciously willing myself not to reach for a cookie. But when stress comes into play, holding myself back becomes even harder. By intensifying my arousal and approach behavior, stress steamrolls over the cognitive voice that had been trying to say no to the cue.

“When you get into this slightly aroused state, the strongest cue in the environment will tend to elicit the motor response it has been associated with in the past,” he said. “It’s a level of affective arousal.”

Periods of transition can make us more vulnerable. Eating foods that are high in fat and sugar seems to be one way to ease the discomfort of “transition emotions.” These are the emotions we encounter as we change from one activity to the next. A meeting ends and we get in the car, or a television program is over and we walk into the kitchen. As our activities change, so does our state of arousal.

“Is there any evidence that food really makes you feel better after you’ve eaten?” I asked Lorna Flowers, a community psychiatrist in San Francisco.

“Absolutely,” she said. “People feel better after eating it. They eat for anxiety. And it soothes anxiety. It really does work like a Valium.” But that effect, of course, is momentary.

When we learn that a stimulus provides gratification, that knowledge drives our wanting, arousing us further. Our focus narrows to the target of our desire, capturing our full attention and directing us toward it. The anticipation of feeling better puts us in a heightened state of focus, making us want it all the more.

What we fail to realize is that the food we ate for comfort has left its mark on the brain, creating a void that will need to be filled the next time we are cued. The result is a spiral of wanting.

In other words, when you’re used to self-medicating to cope with daily struggles, it becomes a habit. Trying to correct and/or change that habit – by simply curbing access to the foods or stopping the habits – means that you’re faced with stressors daily – sometimes, even hourly that you have no way to cope with.

In other words, I fully expect this to turn into depression if you don’t know that the issue is that there is a lack of a coping mechanism, here. Something – a plan of action, a problem solving system, anything – that you can use to help you deal with stressors head-on has to replace your former method of coping with life’s daily stresses.

For me, I was told early on that I needed to develop a coping mechanism by a therapist. My answer was that I kept busy. Whenever I was sitting around and felt a little sad, I’d work out. I’d hit some jumping jacks. I’d go for a walk. I’d tickle my daughter (toddler giggles always cheer me up.) Not thinking about food so much forced me to think about other things. I made food a non-issue, and that meant that I had to keep my mind moving so that it didn’t revert back to the status quo… which was, well, stuffing my face.

I still struggle with coping sometimes, though. I had a pretty irrational temper – when it used to get the best of me – and I find that the more situations I encounter, the more I realize that I have to think before I speak and be thorough when I speak. I can’t let stressful situations linger in my life. I have to be vigilant in protecting myself. Right now, being slow to react (because I can think about why something is triggering my temper and ensure that my solution doesn’t involve food) yet quick in execution when I’ve thought through my plan(because if I’m certain of my plan and have faith in my ability to think it through, why let it linger by being slow about it?) helps me to cope. It’s helped me be a better parent, a better friend and a better woman, overall.

This is why I’m an advocate for therapy, though. Because while it was as simple as developing a better system for coping (this, also, is why yoga is so valuable to me) for me, it could very well be more than that for someone else and only a psychatrist (or psychologist.. either or) would be best able to diagnose something like that. I don’t ever want to discount that.

So what would I say? I’d do what I could to think long and hard about what situations trigger that depressed state within you – consider journaling each day, even – and consider if it’s something you’ll want to address yourself or with the help of someone who is advanced at diagnosing serious mental illness. Trust me – your mind and body will thank you for that.