Brain changes and mood disorders are complication of all eating disorders

Doctors used to associate mood disorders such as depression with psychological factors. But when researchers began to explore the biology, they found that there is a mind-body, cause-and-effect relationship behind these mental illnesses. For example, hormonal changes at menopause can spur mood disorders. In midlife, women are at a higher risk for experiencing hormonal imbalances. These can trigger psychological changes, which then reinvigorate dormant conditions.

In the context of eating disorders, a woman's food behaviors influence her thinking and the circuitry of her brain. To understand this connection, enter your body for a moment in Fantastic Voyage fashion. Imagine you are standing near the lining of your stomach. Normally, hours after a meal your gut will be making appetite-stimulating peptide called ghrelin, which feeds back to the brain to spark hunger. "Hunger," in biochemical language, is nerve cells reacting to ghrelin by releasing transmitting molecules that stimulate the appetite centers of the brain. Your body is feeling the urge to eat.

If you eat, your intestinal tract will be telling your brain, through biochemical feedback mechanisms such as cholecystokinin and glucagon-like peptide-1, to damp down appetite. You will eventually feel full and stop eating. Now, imagine that you are starving. Inside the gut, you are witnessing a molecular crisis. The cells of the brain, far away from your gut, know that they are lacking food. Without it, they will die. And so they send out an alert to get you to eat. Now! It's a molecular siren involving many neurotransmitters, among them serotonin, which is tied to feelings of satiety and fullness.

But if you have an eating disorder, you ignore your brain messages and refuse to eat. The brain sends back to the stomach more chemical signals, more ghrelin, a louder molecular scream, Eat! But still, you override the message. If this is done enough times, you will break your body's mechanisms for sensing hunger and fullness. You will upset the sensitive serotonin balance in your brain. What does it mean to be broken in this way?

Boggiano gives answers with her rats, where culture is not an influence on thought patterns and therefore behaviors relate to biology alone. She showed that after twenty cycles of dieting, foot shock, and bingeing, her rats' brains started making less serotonin, particularly in the brain regions that regulate appetite, body temperature, and reproduction. "This is neuroadaptation," she says. "There is something changing at a fundamental level in the brain." The results translate to people. Researchers have scanned the brains of women with anorexia or bulimia. Women with eating disorders literally lose brain matter over time, enlarging cavities called ventricles, because of their disease. By eliminating their symptoms, they are able to reverse much of this damage - but not all of it. Some of these changes, if left to go on for decades, become permanent.

Psychiatrist Walter Kaye, at the University of Pittsburgh in Pennsylvania, looked at the serotonin systems of women with eating disorders. He measured alterations similar to those of Boggiano's rats. Older women with anorexia make less serotonin than normal women. And the afflicted women also lose their ability to respond to what little serotonin there is, particularly in brain regions that control feeding behavior as well as brain areas identified with fear, depression, memory, flight, motivation, libido, and spatial perception.

Women with bulimia nervosa also have faulty serotonin systems. This may explain why antidepressants such as Prozac, which enhance the effects of serotonin, sometimes help a woman with bulimia to curb her bingeing. It also clarifies why the same drugs do not work in the treatment of anorexia nervosa: starving women do not make enough serotonin in the first place. Prozac has little available to "enhance." Such changes in these and other neurotransmitters may also underlie the depression, anxiety, and impulse control problems that normally plague women with eating disorders. In midlife, women whose faulty serotonin systems already are trying to weather the normal stresses of loss and slumps of menopause are increasingly susceptible to breakdown.

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Brain changes and mood disorders are complication of all eating disorders

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