Eating and Depression: What Food Has To Do With Your Mood
If you’re struggling with an eating disorder concern such as binge eating, it’s likely that challenges with food aren’t the only concern you’re dealing with. Whatever your unique experience with eating happens to be, your issues with food likely aren’t happening in isolation. For example, individuals diagnosed with one of the varying forms of disordered eating such as binge eating or emotional eating commonly also present with other physical complications and/or a co-existing medical diagnosis. Additionally, they tend to also meet the diagnostic criteria for one or more other psychiatric conditions including anxiety and depression.
If this is what your experience has been, then know that what is happening for you is commonly seen. Eating challenges tend to be complex and rarely exist in isolation. And this is one reason why working with a specialized professional can be especially valuable - you want someone who understands the complexity and knows more about addressing all the nuances.
So what else might we typically see happening in addition to your eating problems?
Consider the Following Statistics:
The National Eating Disorder Association shared results of a study which showed “of more than 2400 individuals hospitalized for an eating disorder 97% had one or more co-occurring conditions, including: 94% had co-occurring mood disorders, mostly major depression, 56% were diagnosed with anxiety disorders, 20% had obsessive-compulsive disorder, 22% had post-traumatic stress disorder, and 22% had an alcohol or substance use disorder.”
A 2009 study, published in the International Journal of Eating Disorders, showed one in five women seeking treatment for an eating disorder presented with six or more signs of attention-deficit hyperactivity disorder (ADHD).
Per The National Center on Addiction and Substance Abuse (CASA) at Columbia University, some psychiatric disorders, notably obsessive-compulsive disorder, mood disorders and personality disorders, are common amongst those with eating disorders, with estimates ranging from 42-75%.
Published in Biological Psychiatry, a nationally representative survey revealed 95% of respondents diagnosed with bulimia nervosa, 79% with binge eating disorder, and 56% with anorexia nervosa also met criteria for at least one other mental health diagnosis. And 64% of individuals diagnosed with bulimia nervosa met criteria for three or more co-occurring mental health disorders.
A diagnosis of anxiety is found in 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating disorder.
For those with binge eating disorder, one study found 73.8% of patients presented with at least one additional lifetime psychiatric disorder.
Published in Psychosomatic Medicine, a study involving women with eating disorders found 94% had a co-occurring mood disorder, with 92% of those with depressive disorder.
A study found 55-65% of people with binge eating disorder were also likely to be diagnosed with anxiety disorder.
So we are looking at not only addressing the eating behaviors, but also the underlying psychological concerns, while simultaneously ensuring any physical medical problems are noted and managed. This takes time, effort, and sometimes demands the intervention of multiple professionals.
What Are the Symptoms of Depression?
In regards to depression, between 36-50% of those with bulimia and 33% of individuals with binge eating disorder qualify for a diagnosis of major depressive disorder. Depression can both contribute to the development of an eating disorder and may, too, exacerbate the disordered eating. Either might develop first - so it’s a bit like asking ‘which came first, the chicken or the egg?’ In any case, genuine positive recovery demands attention to resolving both.
A depressive episode might occur one time only during your life or could be something you repeatedly experience. If you’re having a depressive episode your symptoms may be present during most of the day and might include:
Feeling sad, tearful, empty or hopeless
Angry outbursts
Irritability
Loss of interest or pleasure in normal activities
Sleep disturbances, from not being able to sleep to sleeping too much
Fatigue
Low appetite and weight loss
Increased food cravings and weight gain
Anxiety
Restlessness
Slower thinking and/or movement
Feeling worthless or guilty
Dwelling on past failures
Trouble thinking and difficulty concentrating
Having suicidal thoughts
Physical symptoms such as back pain or headaches
The symptoms will tend to be disruptive to your day-to-day life. You may find you feel unhappy but don’t understand why.
Is Depression the Result of a Chemical Imbalance in My Brain?
You might wonder why you’ve become depressed. And you might have heard that it’s due to a chemical imbalance in your brain. But is that really the case?
In short, no. Researchers have eschewed this idea as incorrect and say it is far too simplified. Psychiatrist Dr. Roland Pies has, in fact, advised that “the legend of the “chemical imbalance” should be consigned to the dust-bin.”
Professionals note depression is not simply a problem of having too much or too little of particular brain chemicals. Yes, chemicals are involved. But it is far more complex in that there are millions, perhaps even billions, of chemical reactions occurring throughout the complex, dynamic systems within your body. The chemicals are both within as well as outside nerve cells, influencing your mood patterns and reactions. In addition, there are a myriad of other influential factors at play including genetics, medications, other medical problems, nutrition deficiencies (such as a lack of vitamin B12, a potentially critical point to consider in regards to treating disordered eating and depression), life stressors, and environmental components.
So why does this “myth” persist?
Some suggest it continues to be a popular idea as it gained traction as a perhaps well-intentioned gesture to reduce stigma (it’s just your brain biology and not a character flaw!). However, this gesture does have some potential for harm - people might, for instance, think that their depression is a permanent brain wiring problem which they will have little control over (which is not the case at all and can, in reality, contribute to greater discouragement in that it makes you feel broken and/or helpless).
Then there are some, such as Jonathan Leo, Ph.D., professor of anatomy at Lincoln Memorial University in Tennessee, who sees it another way. Speaking to The Mighty, he observes that “it was really proposed as a very tentative scientific idea and then it quickly morphed into a marketing plan and was picked up by most of the mainstream pharmaceutical companies to market their products.”
Psychologist Dr. Philip Hickey, PhD, adds to the argument, stating that he believes “they (psychiatry, at both the organized and individual level) promoted this fiction even though they knew that it was false, because it suited their purposes and the purposes of their pharmaceutical allies. This falsehood was promoted vigorously by psychiatrists and by pharma, and tragically has been accepted as fact.”
The reality is this: the causes of depression are many. In fact, there may be multiple causes at play even with just one person. And the treatment is, then, also likely to be different for each individual.
Additionally, there isn’t even one type of depression. We recognize, for example, at least two types including endogenous, which is triggered by an environmental cause related to biology, and reactive, which occurs in response to a major life event such as death or divorce. Again, treatment will need to be individualized depending on your unique experience and situation.
Your Mood and Food
So what’s the connection between depression and food? This, too, is a complex issue.
Nutrition can have a profound impact on your health, both physically as well as emotionally. Unfortunately, within the mental health field (and sadly, in most medical practices), it’s a topic which is often overlooked and too frequently misunderstood - does your doctor ask about what you’re eating? or have you been to a therapist before and did they look at your food intake at all?
The topic of food doesn’t come up in most healthcare settings, and it’s barely covered in most health education programs. Yet it’s critically important to consider as research has shown nutrition plays a significant role in many mental health issues, including depression. In my practice, we do closely consider food – not just because I treat disordered eating, but because what you eat (or don’t eat) matters. A lot. For many reasons.
In general, very few people meet the daily nutritional needs of their body. And if you’re diagnosed with an eating disorder, no matter which type, there is a very high probability that you are missing out on a few, possibly even many, micronutrients, for example.
Consider B12. As mentioned above, a Vitamin B12 deficiency has been implicated when it comes to the development of depression. Medical literature actually contains one particularly interesting and extreme case of how important a nutrient can be to the functioning of our mind and emotions – it is the story of a fifty-two-year-old postmenopausal woman who was a lifelong vegetarian. She descended into worsening depression over a nearly two-month long period. She soon became paranoid and began hearing voices. Ultimately, she became catatonic. All treatment failed. Medications were prescribed but no changes were observed. When she happened to be transferred to a new hospital, her vitamin B12 levels were tested. Because she tested on the low side, she was provided a B12 injection. The result? A full recovery.
It is an exceptional case but is nevertheless a compelling example of how a simple nutritional deficiency can have a profound effect on mental health. Notably, animal products like fish, poultry, meat, and eggs are among the best sources for B12.
There are many other nutrients to consider, many of which play a key role when it comes to depression. The main takeaway is that your brain and body can be helped, or harmed, depending on what you’re eating (or, in many cases, not eating). It’s worth taking time to look at.
Anti-Depressant Meds and Nutrition – What Your Doctor (Probably) Won’t Tell You
The decision of whether or not to take anti-depressant medication is a personal one and should include an individual discussion with your healthcare team. The topic of medication is a lengthier, involved subject which is beyond what we are focused on here. But it is, nonetheless, particularly important to be mindful of medications if your eating disorder behaviors are such that you have a nutritional deficiency (which is, as mentioned, highly probable).
Importantly, if you do decide to speak to your doctor about medication (or have already begun taking a prescription), it’s likely that the phenomenon known as “drug-induced nutrient depletion” will probably never come up. It’s not that your doctor doesn’t care. Rather, it’s usually that they simply don’t know. Also, your drug insert won’t provide this information to you.
What’s critical for you to know, in order to proceed with appropriate informed consent, and in order to make a good decision for yourself, is that there have been studies showing that pharmaceutical drugs (including but not limited to anti-depressants) can deplete your body of vital nutrients. This occurs due to such factors as increased excretion of vitamins and minerals, as well as less effective digestion and absorption of nutrients.
So the reality is that you may, prior to beginning a medication, already have a nutrient deficiency which is being exacerbated by your eating disorder. And should you elect to take an anti-depressant, the situation will likely only be worsened. Some of the nutrients which might be depleted include Niacin (Vitamin B3), Folate, Coenzyme Q10, Calcium, and Vitamin D. In some situations, additional symptoms and/or side effects might arise due to the worsened deficiency. It’s often missed, and no connection appreciated, as nutrients are not depleted overnight, but rather over the course of months or years. And again, most medical providers don’t appreciate the role of nutrition or appreciate the potential for depletion due to the introduction of medication(s). You may then find yourself in a situation wherein your doctor thus may either add new medications or increase dosage – never noting the nutritional component that is at play. It can escalate into a troubling and very dangerous cycle.
This may all seem quite overwhelming. I encourage you to continue to learn and do your own research. I suggest reaching out to experts to assist you with your care. And I emphasize that you have tremendous power over your own health and well-being - you can make many positive changes and work toward a different, better future.