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Recovering Your Healthy Body After Being Depressed

Posted Jun 01 2013 9:19am
All of us are familiar with the change in our bodies after a severe flu, broken limb or difficult surgery. Our weakness and inability to move with the same speed and strength possessed before getting sick is due not only to the illness itself, but also from muscle loss. For example, my close relative recently had pneumonia, and the wonders of modern antibiotics brought about a quick end to the chest pain, fever and coughing. More than a week later, however, this normally athletic, fast-moving individual was having trouble climbing stairs and walking long distances. Oftentimes the newly felled by sickness are often unpleasantly surprised to find themselves temporarily debilitated this illnesses, and indeed go through several weeks or even months, of physical therapy and rehabilitation programs to regain our strength and stamina after the bout of sickness is over.

But what if the deterioration of the body is due to mental illness? What if the loss of muscle strength and muscle wasting is due to weeks or even months of inactivity because of the extreme fatigue and weakness that may accompany depression and anxiety? What if an individual is so depressed that moving from a bed to a chair seems too hard, and as a consequence, the lack of days or weeks of physical activity brings about muscle loss and weakness?

Several years ago a woman who had been coming to our weight-management center at a Harvard-associated psychiatric hospital suddenly disappeared. Several weeks later, when her severe depression lifted, she came back and told us that she was unable even to make phone calls during the worst days. The trainer who had been working with her in our program’s exercise routine noticed that she had lost stamina, was unable to do her previous aerobic and strength-building exercise routine, and had trouble with her balance. The days of simply not moving had taken its toll.

She was fortunate, however. The trainer knew what her body was capable of doing before she became depressed and was therefore able to help her regain her former level of fitness.

But what about others whose mental illness causes them to experience periods of physical inactivity as severe as those suffered by someone recovering from injury, infection, chemotherapy or heart disease? Do their therapists recognize the physical debilitation caused by their mental illness? Are the patients given nutritional advice to help them restore lost muscle mass, and are they referred to physical therapists or trainers to restore their lost physical fitness?

While I suspect that these patients are given appropriate medication and therapeutic counseling. But I also suspect that the counseling does not include recommendations as to how to increase muscle mass, increase stamina or improve their balance (a particular problem if the medications make them dizzy).

Because of my decade-long interest in reversing weight gain caused by antidepressants, I have heard from many who have experienced this problem. Most people who contact me write that their medications increased food intake and subsequently their weight. But some insist that they are not eating any differently, and yet their weight increases anyway. They ask if the drugs might be slowing down their metabolism? Unfortunately I am not aware of any studies that compared metabolic rate before and during treatment with antidepressants and mood stabilizers (drugs used for bipolar illness) to see if indeed such drugs decreased metabolic rate. But perhaps if their metabolism is slower, it is not due to the drugs, but due a decrease in muscle mass? Muscles are the greatest users of calories in our body. Thus prolonged inactivity during a depressive episode might deplete muscle mass as readily as it does when someone is forced to stay in bed because of a serious infection or complication of surgery. If so, this would account for a drop in metabolism and subsequent weight gain without a change in food intake?

Fortunately, as anyone who has had a broken limb or bad flu knows, it is possible to reverse muscle loss by exercise and sufficient protein intake. (Women should be sure to eat at least 55-60 grams, and males 75-80 grams, of protein each day.) The same program will work for people who are recovering from mental illness. And if prolonged physical activity has caused major muscle weakness and loss of balance, it should be possible to enlist the service of physical therapist to start the recovery process. It may take time, but certainly will be successful, if given the support it needs.
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