I have been thinking about the relationship between depression and eating disorders for over a year. There is a range of eating disorders, although today I will consider Anorexia Nervosa. In the UK the NICE Guidance 2017 on the subject of treatment of depression in eating disorders has confirmed that there is a need for further research in this field.

About half of my clinical practice there days is with young people with eating disorders, most commonly Anorexia Nervosa. In the history of some cases one observes how a young person experiences severe depression, in the context of stress in relation to perceived experiences with the peer group and academic pressures. Maybe the stress of these experiences can be so intense for young people that it can trigger  the restriction of dietary intake as a coping strategy, which over the course of time develops into Anorexia nervosa.

When a young person is in a starvation mode the body make various adaptations. The brain needs 500 Calories per day at least in order to function. Remarkably the brain has a high content of fat and water. Therefore the function of the brain can be seen to be in a fine balance. Nerve cells need glucose and oxygen to function well. In a starvation state a young person will not consume enough carbohydrate to therefore make enough glucose available for brain function. Additionally this person may not be active enough and may have reduced regional blood flow in the brain, leading to less delivery of oxygen to the frontal lobe, anterior cingulate cortex and hippocampus, which in turn would predispose to the experience of depression and suicidal ideation.

Most young sufferers with Anorexia Nervosa do not eat more than 1000-1500 Calories per day prior to their presentation to getting more help in mental health services. Generally consuming 1000 Calories per day may in some instances enable a young person's weight to be unchanged, but the with such a low intake the function of the brain would be compromised to the extent that the young person experiences stress, voice hearing , depression and suicidal thinking. In the treatment of Anorexia nervosa improved food intake, more than antidepressant medication and psychological therapy will help the brain recover its function and alleviate the burden of the depressive experience.

I will return to this important topic in a future blog. In the future I would like to design a study looking in to this area.