November 28, 2012

Depression, Obesity, and Binge Eating

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Paul King, MD

Parkwood Behavioral Health System, Olive Branch, Mississippi


Atypical depression is associated with a higher risk for obesity than is found in the general population, while melancholic depression is not, as was noted in the blog entry by Robert D. Levitan, MD, that summarized an excellent, well organized study. Classic melancholic depression is associated with appetite loss and insomnia, whereas atypical depression is associated with increased appetite and hypersomnia.

In overeaters, food becomes like a drug and its use is just as compulsive as using alcohol or pills, as Caitlin Moran pointed out in a book excerpt in the June 15, 2012, Wall Street Journal. The compulsive pattern of “unhappy eating,” as she calls it, is the consumption of greater than normal amounts of food until the anxiety or depression is temporarily satiated by “an almost meditative routine of chewing and swallowing.” The chosen foods have large amounts of fat (eg, chocolate, ice cream, butter), carbohydrates (eg, bread, bagels), or sugar (eg, candy). The person then experiences relief from the symptoms, followed by feelings of guilt, which cause her to stop eating. The behavior is socially acceptable because it is often done in private and the person does not become intoxicated or “high.” She can still safely drive a car or tend to child care duties. She is not impaired like she would be by taking opioids in combination with benzodiazepines. Moran says, “It’s a way of screwing yourself up while still remaining functional, because you have to. Fat people . . . are slowly self-destructing in a way that doesn’t inconvenience anyone.”

It is interesting that the DSM-5 development group of the American Psychiatric Association proposed making binge eating disorder (BED) a distinct diagnosis in psychiatry. In the rationale are (1) the close relationship to, but differentiation from, other eating disorders and (2) the usefulness of psychiatric medications. In obese people without BED, antidepressants are generally not helpful.

A study of BED as a subtype of obesity used the interesting phrase “hedonic properties of food.” The study suggested that people with BED are biologically motivated to eat (or overeat) as a reaction to emotions rather than to appetite, and food becomes an abused substance, as in any addiction. Other obese people overeat passively, without thinking.

It may be very useful to look at BED as a subtype of atypical depression. If BED is a subtype of atypical depression, the “increased appetite” associated with atypical depression may actually be an increased response to the “hedonic properties of food.” Psychopharmacologic interventions that are appropriate for atypical depression, then, may be effective for BED.

Financial disclosure:Dr King had no relevant personal financial relationships to report.​

Category: Depression , Eating Disorders
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