Poll & Research: Does Your Depression Increase or Decrease Your Appetite?

[20thcenturyfox]

In your experience with MDD, do you have increased appetite for food...or decreased appetite for food? The last 2 options in the poll are for "neither" or "other." Your comments and insights are welcome.

Depression, or MDD, (like ADHD) has always seemed to me like one of those useless "kitchen-sink" diagnoses which lumps together a collection of loosely similar, but clearly heterogeneous, conditions-- which confounds research and defeats intelligent diagnosis and treatment. What is the point of determining that 59% of subjects respond to a treatment when it is unknown how many of the subjects even had the same type of depression in the first place? Let alone, what types of MDD the non-responders had?

One obvious example is that in the classic-but-now-rejected "melancholy" type of depression, sufferers tended to lose their appetite for food, whereas those of us with "atypical" depression tend to have increased appetite for food. Calling both MDD and giving both the same pills never made much sense to me.

Recently some interesting research has seized on this appetite divergence and --using functional magnetic resonance imaging and blood assays--teased out a number of additional hormone and immune differences between these 2 groups, so that they stand out more distinctly as 2 different conditions or response patterns.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292746/ Appetite Changes Reveal Depression Subgroups with Distinct Endocrine, Metabolic, and Immune States (2018)

Wouldn't it be great if this brings us closer to the day when we can recognize and treat appropriately each of, say, 4 or 5 different MDD subtypes?

Can ADHD be far behind?

[namazu]

Like you, I'm an eater when depressed. I also tend towards hypersomnia and/or a (more-)seriously-out-of-whack-(than-usual-)sleep-cycle, rather than straight-up insomnia.

I recall reading somewhere -- no, I don't remember where and don't have time to look it up at the moment, so treat with caution -- that "atypical" depression may actually be more common than "typical" depression -- go figure!

It's interesting to me that the lines separating "unipolar" from "bipolar" mood disorders have gotten shakier, on the one hand, and on the other hand, we're finding the types of differences you describe within formerly unitary categories. I guess that's very much to be expected when we humans attempt to impose our own constructs on nature.

Of course, to be fair, science is an iterative process. What comes before -- including the errors and omissions, which are manifest in hindsight -- help us learn.

I share your hope that this ongoing research will lead to meaningful improvements in clinical diagnosis and treatment (rather than just infinite shuffling of labels).

[aeon]

There have been times when I have been melancholic and times when I have been atypical, with the associated changes in appetite.

I have been predominantly melancholic, so I voted accordingly.

Cheers,
Ian

[Greyhound1]

Major decrease for me. My depression brings on lots and lots of anxiety which trigger fight/flight responses and my stomach instantly shuts down. I could be very hungry and have just one negative thought and instantly lose my hunger and the ability to eat. I could easily go all day without eating which caused more anxiety and further ruining my chances. Choking down a protein shake sometimes is the only way I can get any calories at all.

When I’m not depressed, I enjoy food and like to eat.

[excel]

I can eat, while being depressed

[Rebelyell]

Both.if I have bad anxiety it feels like the gestapos got a boot on my throat.if I'm depressed I eat alot of junk.food like ice cream n Mac n cheese.sometimes all I wanna do is sleep n other times I'm off n on

[VietnamVet]

It can cause me to not eat for days.

[CharlesH]

For me, definitely decreased appetite (and I voted in the poll).

[tudorose]

Other. I don't feel hungry. I don't want to cook anything but of food is presented I will eat it. That's been the last week for me.

[SashaBV]

I cycle through both lack of appetite from too much mis-firing in brain circuits and more eating because of boredom, unhappiness, or self-medicating with foods that bring comfort or deja vu from better days.

[20thcenturyfox]

For those who made it through the details of what hormones and markers were elevated or depressed in which group, did you have any new thoughts or ideas about what is going on in your depression?

For example, if you happen to be an "Appetite-Up" type, you can't miss all the signs of systemic and brain inflammation in these markers. If you happen to be an "Appetite-Down" type, you might guess there is still a lot of inflammation, but it is being held down (or masked?) by high cortisol, which is a different sort of problem with its own health risks.

(If you are both or neither, maybe you cycle between these 2 patterns, or maybe you have a different pattern entirely.) But for both these classic patterns, these seem like dangerous processes to have going on for years, unchecked, as most of us likely have.

I see I have been slow to understand that in the last 20 years depression has come to be recognized as an "inflammatory" disease process. How could it be inflammatory when it feels so...dull and cold?

Seeing results like this helps bring it home to me that behind the dull cold subjective experience of (treatment-resistant) depression is a fair amount of hot, threatening inflammation (and hormone dysregulation) I might actually be able to do a few things to moderate.

[excel]

Adderall and reptilian should decrease your appetite

[20thcenturyfox]

Originally Posted by 20thcenturyfox

you can't miss all the signs of systemic and brain inflammation in these markers. If you happen to be an "Appetite-Down" type, you might guess there is still a lot of inflammation, .

this March, 2019 article in the journal Pharmaceuticals (Basel) cautions that just as "depression" is likely to be heterogeneous with various subtypes to be elucidated, so also "inflammation" is likely not a single phenomenon or cause, but a composite made up of various observations which don't necessarily all occur together, or even have similar effects.

Coming to clearer operational definitions of types of inflammation and stress can, in turn, be expected to favor translational research between the clinic and basic science.

Clearer definitions and specification of subtypes rather than using poorly-defined accommodating ‘umbrella’ concepts could also indicate alternative interpretations of and explanations for phenomena. For example, an increase in IL-6 or CRP alone does not necessarily imply that inflammation is ongoing, but may be part of tissue repair or anti-inflammatory responses. Also, it is not because a drug has antidepressant or anti-inflammatory properties that all of its effects necessarily indicate that depression or inflammation was ongoing. It is safer to interpret its effects in terms of biochemical structure or function and acknowledge all of its potential sites of actions, for example as a serotonin-reuptake inhibitor that may affect serotonin signaling both in the brain and body of animals. Finally, inflammation or increases in potential biomarkers of inflammation should not necessarily be treated as a potential cause of depression and could even be a consequence. Interestingly, major depression has long been known to be associated with increased circulating noradrenalin concentrations [54,126]. Moreover, increased noradrenaline concentrations have, under some circumstances, been shown to stimulate pro-inflammatory cytokine expression and the pro-inflammatory NF-κB intracellular signaling pathway [127,128]. It seems therefore possible that part of the inflammation proposed to cause major depression in immunopsychiatry could be the consequence of changes in catecholamine concentrations. Inflammation and Depression: A Nervous Plea for Psychiatry to Not Become Immune to Interpretation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469164/

In other words, just because there's CRP or IL-6 does not necessarily mean there is inflammation occurring, let alone causing it. But for us--down here in the dark feeling our way-- maybe it's not a bad working hypothesis.