Dieting Depresses
November 2000; Volume 2; 84-85
Source: Smith KA, et al. Impaired regulation of brain serotonin function during dieting in women recovered from depression. Br J Psychiatry 2000;176:72-75.
Design/Setting/Subjects: Nineteen women with at least one episode of DSM IV major depression who were fully recovered and had not taken medication for at least six months. The control group consisted of 23 women with no personal or family history of any Axis I psychiatric disorder. Subjects were placed on a three-week calorie controlled diet of 1,000 kcal/d. Subjects completed a daily diary of what they ate and recorded scores on visual analog scales (happy, sad, and irritable). Neuroendocrine testing utilizing prolactin response to intravenous tryptophan infusion was done at baseline (during the early to mid-follicular phase of the menstrual cycle) and again at the end of the third week of dieting. Subjects waited a week after the first neuroendocrine test before beginning to diet so that neuroendocrine testing could be done in the same time of the cycle.
Results: Twenty-five subjects successfully completed the three-week protocol. Prolactin responses to tryptophan were similar in both groups prior to dieting. Dieting significantly decreased baseline tryptophan levels in both groups. After dieting, however, prolactin response to tryptophan infusion increased in the control group but not in the formerly depressed group. Relative to the control group, VAS ratings in the formerly depressed group were lower for the " happy" scores; there was no difference in "sad" or "irritable" scores.
Funding: Medical Research Council.
Comment: Some of the mechanics of this interesting study lost me; the protocol for neuroendocrine testing is quite complicated, and apparently women who did not lose at least 2 kg on the diet were dropped from analysis because prior work by the authors showed that such patients do not reliably increase prolactin response to tryptophan. But the authors sound reasonable enough. Depressed patients are known to show blunted endocrine responses to tryptophan, but the authors counter that potential criticism by pointing out that these responses normalize with clinical recovery. The concept that women vulnerable to major depression show impaired regulation of brain serotonin function during calorie-restricted diets has obvious clinical implications.
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