EDs

[Psyclops]

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Walter Kaye at UPMC has done some studies showing disorders of the 5HT system that might shed some light on EDs. It may be that the 5HT anomolies are premorbid, and the EDs are attempts at self-medication. If so, that would also explain some of why ED pts hold on to their disorders so closely. The studies showing abnormal levels of 5HT in the CNS suggested that the starvation might be a way of reducing the amount of tryptophan available, thus reducing 5HT. Since the excess 5HT is associated with anxiety, reduced dietary tryptophan resulting in reduced 5HT would reduce anxiety. So, self starvation as an anxiolytic, however crazy that might sound.

This was being talked about on the psychology forum, what have you guys heard about this?

 

[Doc Samson]

This was being talked about on the psychology forum, what have you guys heard about this?

Haven't heard anything specifically about this. Empirically, we treat anxiety disorders with serotonergic meds (specifically SSRIs), so restricting serotonin seems counterintuititive. For my $0.02, there is no diagnosis more dynamically influenced than AN... it's all about control. I try to formulate all my cases with an eye on the interplay of biology and environment, and don't doubt that the environmental issues of AN likely produce a neurotransmitter effect, but to my mind you have to treat the cause, and in anorexia that means therapy.

 

[icebreakers]

is excess serotonin associated with anxiety? why do we prescribe SSRIs for anxiety then?
i've always found this really confusing. also, how do some drugs work as anti-depressants and anxiolytics (i.e. some of the SSRIs like lexapro...which was developed for depression and recently approved for anxiety )

with EDs, and in regards to UPMC study,, does he mention any possibility of patients self-medicating in the opposite direction? overeating/binge instead of starving?

I wonder if the establishing of any habit/behavior, once deeply rooted(habit motivated by insecurity with body image for example), will cause/be associated with some sort of chemical/physiological anxiety state in the brain when the individual abstains from that same habit.

what once started out as starving for a body image, develops into an addiction of its own, which brings along its own withdrawal symptoms when the individual deviates from their ED.

if that is at all possible, how can we take full advantage of this phenomenon...
basically, get ourselves addicted to healthier lifestyle choices and behaviors. its like, why are some people so committed to their diets, or maintaining their health? in both moderate and excessive ways. is their much research available on how to choose what we use as our 'self-medicating medication'?
train a patient with high riskfactors for depression, to feel anxious whenever they abstain from their daily walking schedule.

 

[Psyclops]

Well, the way I would see it, if this were to be the case, I would imagine that it would be more selective, such as not eating chocolate, cheese, wine, turkey, millk, etc.

 

[MBK2003]

I try to formulate all my cases with an eye on the interplay of biology and environment, and don't doubt that the environmental issues of AN likely produce a neurotransmitter effect, but to my mind you have to treat the cause, and in anorexia that means therapy.

I agree wholeheartedly.

The CBT model of eating disorders, in my experience, has fit most of the patients I encounter.

Low Self-Esteem --> Excessive Concern About Shape/Weight --> Rigid Dietary Rules --> Binging --> Purging/Compensatory Measures

with all the appropriate feedback loops.

Also, there's no evidence that SSRI's work at low weight regardless of refeeding status.

MBK2003

 

[Doc Samson]

I agree wholeheartedly.

The CBT model of eating disorders, in my experience, has fit most of the patients I encounter.

Low Self-Esteem --> Excessive Concern About Shape/Weight --> Rigid Dietary Rules --> Binging --> Purging/Compensatory Measures

with all the appropriate feedback loops.

Also, there's no evidence that SSRI's work at low weight regardless of refeeding status.

MBK2003

An alternate more dynamic model might look something like:

Feeling out of control/under the control of others --> seizing control of the one thing you can (i.e. what you eat) --> feeling in control of yourself --> gaining control over others who now spend a great deal of time worrying about your nutrition

Anorexics buck much harder than even the most hardcore opiate addict when you try to take control away from them by instituting a diet plan. A medically unstable anorexic is my nightmare consult... the general hospital is just not cut out to handle them.