From weight loss to weight gain: appetite changes in major depressive disorder as a mirror into brain-environment interactions

Abstract

A SHIFT IN THE APPETITIVE SYMPTOMS OF DEPRESSION In recent decades, there has been a profound shift in the appetitive characteristics of depression. For early measures of depression, such as the Hamilton Rating Scale for Depression (HRSD; Hamilton, 1960), the key appetitive characteristic of depression was weight loss. In the 1950s and 60s, reduced appetite was considered a key feature even in mild depression and it was noted that in moderate depression the desire for food may almost totally disappear (Beck, 1967); those suffering with severe depression may almost have to force themselves to eat (Schuyler, 1974; Polivy and Herman, 1976). Zung, another pioneer of depression measurement, found that even the individual designated as the significant “other” associated loss of appetite as symptomatic of depression in the patient (Zung et al., 1974). No assessment for increased appetite, food intake, or weight gain was assessed in the HRSD. In these early reports, people with depression who overate or gained weight were diagnosed with “atypical depression” and were treated differently than those with more “typical” depression characterized by weight loss. Yet, this understanding of depression has shifted, with weight gain and increased appetite being identified as a “typical” symptom of depression among those with the disorder today (Doraiswamy, 2013), as is also evident as a common symptom for many other disorders involving emotional distress (American Psychological Association, 2013). Indeed, a recent representative US national survey of 43,093 adults found that the prevalence of major depression with atypical features was almost 40% higher than that of depression without atypical features (Blanco et al., 2012). In this survey, factors that predicted atypical depression appear to mirror the growth of obesity and over eating in our society as a whole.