Entenda a relação entre obesidade e depressão

Nos últimos anos os estudos epidemiológicos tem mostrado um aumento na prevalência de depressão e obesidade e uma aparente relação entre essas duas doenças. Várias pesquisas demonstraram que o risco de depressão entre pessoas obesas e o risco de obesidade em pessoas com depressão são aumentados. A depressão aumenta o risco do desenvolvimento de obesidade em 58% e a obesidade aumenta o risco de depressão em 54%. E o risco é maior se a obesidade for central, aquela em que há acúmulo de gordura entre os órgãos abdominais.

Essa relação pode ser observada em adultos, adolescente e idosos. Em adolescentes com depressão o risco de obesidade é 70% maior e naqueles com obesidade o risco de ocorrência de depressão é 40% maior. Entre idosos também foi identificado um risco aumentado de depressão, principalmente quando a obesidade é acompanhada de perda da massa muscular, o que é chamado de sarcopenia.

Qual a ligação entre essas duas doenças? A resposta é: Inflamação. Tanto a depressão quanto a obesidade são doenças inflamatórias, o que pode te deixar surpreso. Nos últimos anos nossa visão sobre o que essas duas doenças são mudou muito. Hoje não pensamos mais que o tecido adiposo é um estoque de gordura do corpo, apenas uma reserva. Ele é um órgão ativo e produtor de hormônios. Mas também produz fatores inflamatórios, que chamamos citocinas. A depressão também não é apenas uma alteração de neurotransmissores. Muitos estudos nos últimos anos mostram que na depressão essas mesmas citocinas inflamatórias estão muito aumentadas. Quando mais aumentadas maior a gravidade da doença, inclusive com associação suicídio.

O que sabemos hoje é que essas duas condições se relacionam de forma bidirecional. Uma aumenta o risco da outra. Uma pode ser a causa da outra com a inflamação fazendo a ponte entre elas. As substâncias inflamatórias produzidas na obesidade são capazes de alterar a liberação de serotonina nos neurônios. Quando essa inflamação ocorre, uma enzima chamada IDO (indolamina 2,3 dioxigenase)  é ativada no cérebro e ela usa o triptofano (o nutriente que é usado para produzir a serotonina – hormônio do bem estar) para produzir a kinurenina, levando à modificação em vários mecanismos que conduzem ao mal funcionamento dos neurônios e à depressão. Além disso, várias outras alterações metabólicas contribuem para a produção do cortisol, o hormônio do estresse, que também leva ao acumulo de gordura abdominal.

Resumindo: para conseguir vencer essas duas doenças crônicas tão incapacitantes devemos atacá-las de maneira correta, ou seja, intervindo nas duas ao mesmo tempo. Por isso são importantes mudanças de estilo de vida na depressão e o tratamento da saúde mental no manejo da obesidade. Iniciar atividade física e adotar uma dieta saudável são fundamentais para a boa resposta no tratamento da depressão.

About Luiz Carlos

Luiz Carlos é médico psiquiatra, PhD em Ciências da Saúde e professor na Faculdade de Medicina da Universidade Federal de Uberlândia. Coordena a Liga Acadêmica de Inovação em Saúde e o ambulatório de Psicogeriatria da Residência Médica de Psiquiatria da UFU. Também é pesquisador na áreas de genética psiquiátrica e do comportamento no Laboratório de Genética da UFU. Além disso estuda terapia de aceitação e compromisso, metodologias de ensino multimídia e inovação em saúde, psicologia positiva. Membro da Associação Brasileira de Psiquiatria e da Association for Contextual Behavioral Science. Sócio da Associação Brasileira de Nutrologia.

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