Treating the Physical Effects of Depression By Judith Wurtman, PhD on 1/17/19 - 11:46 AM

The quick deterioration of our bodies following severe flu, broken limb or difficult surgery is often surprising. We quickly and abruptly transition from feeling strong, energetic and balanced with a full capacity to eat, walk and climb stairs, to feeling weak, exhausted and frail with little appetite or mobility. In short, debilitated. A close relative recently had pneumonia; fortunately, the wonders of modern antibiotics brought about a quick end to the chest pain, fever, and coughing. But more than a week later, this normally athletic, fast-moving individual was having trouble climbing stairs and walking long distances. It took him weeks to regain his physical strength and overcome the fatigue that had him longing for a daily nap. Indeed, it may take several weeks or even months of physical therapy and rehabilitation programs to regain strength and stamina after the end of an acute or severe illness.

But what if the deterioration of the body is due to mental illness? What if the severely depressed individual stops eating and rarely moves from her bed in a darkened room for days at a time? What happens when anxiety is so pervasive that chronic gastrointestinal disturbances and sleep disruption result? What about a person with bipolar disorder who cycles into depression with such frequency that there is little time for recovery from the previous depression? Wouldn’t such circumstances bring about reduced nutrient intake, loss of weight due in part to loss of muscle mass, difficulty with balance, and overwhelming exhaustion—similar to that seen after a physical illness such as pneumonia or severe flu?

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Several years ago, a client with bipolar disorder who had been coming weekly to our weight-management center at a Harvard University-affiliated psychiatric hospital suddenly disappeared. Phone and email attempts to remind her of the meetings and to check on her well-being were ignored. Weeks later, she appeared and told us that she had been severely depressed and unable to get out of bed to answer the phone. She had lost weight due in part to muscle loss because of her inadequate nutrient consumption and inertia. The clinic’s exercise physiologist noted that our client’s physical stamina and balance had declined significantly, and her balance was precarious.

Fortunately, we were able to establish a meal plan and exercise routine to compensate for the days in which she was inadequately nourished and inert. But what happens to other patients whose mental illness, whether acute or prolonged, causes periods of almost total physical inactivity, inadequate nutrient intake, even lack of exposure to sun and fresh air? They may be as debilitated at the end of their episode of depression or anxiety as someone recovering from injury, infection, or a broken limb. Who recognizes their fragile physical state and takes steps to ensure their physical rehabilitation?

Therapists may play a crucial role in facilitating the help these patients need to bring about an improvement in their physical as well as mental state. They may be able to encourage the patients to seek out medical attention if needed, to consult with a dietician about restoring adequate nutrient intake, or to suggest using physical therapy to restore lost muscle mass and stamina. Moreover, with the permission of the patient, it might be useful to bring the caregiver into this discussion to help make appointments with these health care specialists and to discuss ways of preventing the physical decline when or if the depression recurs. It makes good clinical sense that the psychotherapist might just be that person.    

File under: The Art of Psychotherapy, Musings and Reflections