Eating Disorders, Depression, and Bipolar Illness

by Paulette G. Lane

On January 9, 2001, Pauline Powers, M.D. spoke to the Tampa Bay Depressive and Manic-Depressive Association about Eating Disorders and their relation to Bipolar and Major Depressive Disorders.

Dr. Powers first discussed definitions, diagnoses, and treatments for each of these disorders. Symptoms of Bipolar Disorder include flights of ideas, over-reactiveness, increased self-esteem, talkativeness, decreased need for sleep, and increased interest in sex. Symptoms of Major Depressive Disorder include depressed mood, loss of interest in activities, weight loss, sleep problems, decreased energy levels, decreased self-worth, hopelessness, recurrent thoughts of death or suicide, indecisiveness, loss of interest in sex, feelings of guilt, and somatic complaints. Dr. Powers also described Rapid Cycling Bipolar Disorder and Dysphoric Mania in which symptoms of depression and mania occur simultaneously and in which mood is often irritable rather than euphoric.

Eating and Weight Disorders are common among those with Mood Disorders, and 50-80% of patients with Eating Disorders also have a Mood Disorder. Approximately 10-20% have Bipolar I disorder, and approximately 40% have Bipolar II disorder. Such close relationships present problems for treatment, because weight gain and weight loss occur with both Mood Disorders and their treatments. In these cases, the clinician must find weight-neutral antidepressants and mood stabilizers. For instance, certain antidepressants such as Wellbutrin, should not be used when depression is complicated by an Eating Disorder.

Dr. Powers described diagnostic standards for Eating Disorders. Anorexia Nervosa is diagnosed in the presence of weight loss of 15% of IBW (Ideal Body Weight), an intense fear of obesity, body image disturbance, and amenorrhea (for three months) in females. There are two types of Anorexia Nervosa, the Restricting type, which includes over-exercising, and the Binge Eating/Purging type. Bulimia Nervosa includes recurrent episodes of binge eating of large quantities of food twice weekly for at least three months, a sense of loss of control, body dissatisfaction, non-fasting between episodes, and obesity. Night Eating Disorder is another common problem, existing in about 7% of the population. Symptoms include eating 25% of daily calories after the evening meal, insomnia and morning anorexia.

Eating Disorders are serious illnesses. Eighteen percent of anorexic patients and 5-10% of bulimia patients die within 20 years. In some case, diabetic patients withhold their insulin to decrease their weight. Also, the weight gain of Bulimia has deleterious effects on the body, including hyperlipidemia (thus increasing heart attack risk) and Type II Diabetes Mellitus.

Many antipsychotics, antidepressants, and mood stabilizers present significant problems in treating patients with Eating Disorders. Clozapine and Olanzapine both cause significant weight gain. Seroquel and Risperidone cause minor weight gain, and the typical antipsychotics cause a moderate weight gain. Aripriprazole seems to be weight neutral. Aripripazole is an antipsychotic in Phase III Clinical Trials. The antidepressants, Amitryptiline, Imipramine, Mirtazepine, and Buproprion all cause weight gain. Fluoxetine causes weight loss. Paroxetine, Venlafaxine, Sertraline, and Nefazadone seem to be weight neutral. Clozapine and Buproprion also increase the risk of seizures. Among mood stabilizers, both Lithium and Depakote cause weight gain. Olanzapine can cause a 30-40 point weight gain. Gabapentin causes minor weight gain, and Topiramate causes weight loss. Carbamazepine seems to be weight neutral and Lamotrigine’s effect on weight is unknown at this time.

One important new medication for Bipolar Disorder is Topiramate (Topimax), an anti-seizure medication which does not cause weight gain. Topiramate works by enhancing the activity of the inhibitory neurotransmitter, GABA (gamma amino butyric acid), and by antagonizing some types of glutamate receptors. The University of San Francisco is running a study of Topiramate for patients with Bipolar Disorder. It is a double blind, placebo-controlled study in which patients participate in a brief hospital stay to discontinue their medications and begin either the new drug or a placebo. It is an “open label” study, and will last for a year.

In conclusion, Dr. Powers noted that we need to recognize the relationships between Eating and Mood Disorders. We need to recognize the importance of treatment, and we need to continue research to find new medications. At present, Prozac is the only medication approved by the Food and Drug Administration for Bulimia Nervosa. However, many new medications are in the developmental phases for both Mood and Eating Disorders.

Reprinted with permission from Tampa Bay DMDA (Depressive and Manic-Depressive Association) Newsletter, April-May 2001.