So many of us have to deal with things that are not fair – depression, unsupporting spouses, financial reversals, weight gain, etcetera, it can be tempting to launch a protest of some kind against the unfairness.
These protest actions don’t have to be obvious at all, but they can have powerful effects, nonetheless.
A few women recently told me, “I would be less depressed if I was not so fat.”
As a psychiatrist, I sometimes feel defensive when someone tells me that, not because I disagree with the goal of having a healthy weight, but because it seems to put a barrier in front of the goal of reducing depression.
Even though the sentence seems to be merely reporting a subjective fact (I know this about how I feel) it may be doing more than that, it may be also serving as a protest against being fat – sort of like the protest of a child when there is something unfair going on (“I am going to hold my breath until I am treated fairly”). In other words it might not be saying, “this is how I am, and I know it is a problem to set conditions on improving my mood, but I still haven’t figured a way around how my weight affects my mood…” but rather…. “I am not going to do the things that I know would improve my mood until someone (the universe? God? my psychiatrist?) gets my weight down….”
Sometimes a protest can be effective. We all know about injustices that have been corrected due to the action of a small dedicated group of individuals. But these kind of protests are very unlikely to achieve their goal (losing weight, getting treated better, finally getting paid what I deserve) and can be remarkably effective at preventing someone from getting less depressed.
And it is not infrequently the case that a more creative solution to the basic problem (weight loss, etcetera) can be found and acted upon once the depression lifts.
Perinatal Mood Episodes Common in Women with Bipolar Disorder
Women with bipolar I disorder had higher risk for mood episodes within 6 weeks of delivery than those with bipolar II disorder or recurrent major depression.
All mood disorders tend to recur during pregnancy or the postpartum period, but does the frequency and timing of recurrences vary by type of disorder? To find out, U.K. investigators examined reports of affective episodes during and after pregnancy in 980 women with bipolar I disorder (BDI), 232 with bipolar II disorder (BDII), and 573 with recurrent major depression (RMD).
A similar proportion of women in each diagnostic group (71%–74%) reported an affective episode in pregnancy or within 6 months of delivery sometime during their lives. The risk for a mood episode within 6 weeks of delivery was significantly higher with BDI than with BDII or RMD; more than 20% of pregnancies or postpartum periods in the BDI group were accompanied by mania or psychosis, and 25% were accompanied by depression. Within 4 weeks of delivery, women in the BDI and RMD groups were significantly more likely to experience an episode than those in the BDII group; mania and psychotic depression were most common in the BDI group. In all diagnostic groups, mood episodes were significantly more common during the first month postpartum than during pregnancy. Depression during pregnancy was more common in the RMD group than in either bipolar group.
Postpartum Depression in Women
Maternal depression across the postbirth period has long-term negative consequences for infant development. Little is known of the neurobiological underpinnings, but they could involve oxytocin, a neuropeptide that is dysfunctional in depression and is implicated in birth and parenting.
The authors recruited a community cohort of women with high or low depression scores 2 days after childbirth and measured depression again at 6 and 9 months. When the child was 6, the authors evaluated the families of 46 chronically depressed mothers and 103 mothers reporting no depression since childbirth. The child was assessed for psychiatric diagnoses, social engagement, and empathy. Mother, father, and child were tested for salivary oxytocin level and variation in the rs2254298 single nucleotide polymorphism on the OXTR gene.
Of the children of the chronically depressed mothers, 61% displayed axis I disorders, mainly anxiety and oppositional defiant disorder, compared with 15% of the children of nondepressed mothers. In the depressed mothers’ families, salivary oxytocin was lower in mothers, fathers, and children. These children also had lower empathy and social engagement levels.
In addition, the rs2254298 GG homozygous genotype was overrepresented in depressed mothers and their families, which correlated with lower salivary oxytocin. Presence of a single rs2254298 A allele (GA or AA genotype) in depressed mothers markedly decreased risk of child psychopathology.
The negative effect of chronic maternal depression on child social outcomes was related to genetic and peripheral biomarkers of the oxytocin system. This suggests a potential for oxytocin-based interventions in depression treatment.
A danger of Hypothyroidism is that it is 10 times more common in women. This sex difference however, does somewhat subside as people get older. The most at risk individuals for this disorder include postpartum women, people with head or neck surgeries, and individuals experiencing endocrine conditions (diabetes).
The signs of hypothyroidism are non-specific, which is why it is so easily confused with other disorders. Some common symptoms exhibited in those affected are decreased rate of metabolism, accumulation of glycosaminoglycans, cold intolerance, dry skin, muscle cramps, and low levels of circulating thyroid hormones.
Common effects of the disorder also include depressed mood, poor concentration, weight change, memory issues, and low energy. If you are experiencing these symptoms and have been diagnosed with a different disorder, yet find current treatments ineffective, it is advisable to start the conversation about hypothyroidism.
The Struggle to Find Motivation
Today, I met with a couple of women whose central concern was the fact that they felt a complete loss of motivation. One of these women is finishing graduate school. Only a few weeks away from graduating, she has found that she is not completing the assignments that she needs to in order to graduate. She knows that she can do them, but all that she seems to be spending her time on is reading romance novels and watching TV. She has also been avoiding contact with people; so much that her mother almost called the police to do a welfare check to make sure that she was alright.
The other woman has had her own big challenges to deal with. She discovered that she has rheumatoid arthritis. In the same year the diagnosis was made, she also needed to get a hip replacement. She’s always been incredibly hard working, successful, very healthy, and energetic. However, she came to me reporting that she was feeling unmotivated and that she found her lack of motivation to do anything very disturbing as well as frustrating. She said she’s never had this experience before. Both of these bright and confident women found themselves wrestling with a problem that made no sense to their thinking minds.
I began by trying to assess with both of them whether they were really ready to make a change. Often, being unmotivated has its own motivations. Finding that you can’t do something may be a good way of dealing with anxiety about how well you would accomplish the task if you really tried. So, a good first start is trying to figure out whether or not the person is really ready to make a change. It seems that they both were, but the key question was, would trying to change this problem be successful?
With one of the two, it became clear after a half an hour conversation, that one of the major contributors to her lack of motivation was the fact that she was, as she put it, “having a tantrum.” She was not actually all that excited anymore about the subject of her graduate thesis, and recognized that her behavior was, in some ways, similar to behavior that she had as a child when she was told she had to finish work at school that she didn’t want to do. Just identifying the sullen child within her was quite helpful. The other woman was a bit more complicated. We needed to find things that could enhance her sense of energy. That energy that she had always had as a healthy person was really important in terms of her past high motivation. We focused on trying to improve her sleep, but also trying to improve how she woke up in the morning. We discovered that one of the things that had in the past made a big difference in terms of optimism was starting the morning out in the sun, having breakfast out on her patio. We also worked to improve the way she was taking her pain medications, so that her sleep would be less disrupted.
Losing motivation is a complicated problem. Looking for missing energy, whether from depression or from a loss of physical energy, and being very attentive for a sullen child lurking within, are a couple of ways that you might be able to turn things around when dealing with this problem.