How to Treat a Depressed Anorexic
About half of all people with eating disorders also have depression. The best treatment approach involves addressing both problems at the same time. Counseling techniques that help people control both persistent sadness and the urge to restrict food can give people very real tools they can use to gain control and then stay in control for the rest of life.
According to the National Association of Anorexia and Eating Disorders, nearly 50 percent of individuals with eating disorders satisfy the diagnostic criteria for depression.
The starting place of treatment for co-occurring eating disorder and depression is to receive a medical diagnosis. The Diagnostic and Statistical Manuel of Mental Disorders-5 (DSM-5) sets forth the criteria for a doctor or mental health professional to diagnosis, and gauge the severity of, anorexia nervosa and depression. Although these are separate disorders, depression and anorexia are often linked.
The Link between Anorexia and DepressionStudies show that depression can be a risk factor for developing anorexia, but the reverse relationship can be true as well. Studies show individuals who have an eating disorder can develop depression. In the latter case, the physiological changes to the body involved in anorexia, such as low body weight, can trigger a depressed mood. When two disorders co-occur, it is often difficult to establish which came first. However, an inability to definitively know whether two disorders have a correlative or causal relationship is not a bar to treatment.
From a psychiatric standpoint, the form of depression involved in anorexia can have distinct features, whether the two conditions co-occur or one causes the other. For instance, a person with anorexia often has a desire for perfectionism. This desire may be a symptom of underlying depression (i.e., the individual is chronically depressed due, in part, to a perceived inability to meet a desired standard of beauty). As anorexia and depression occur with some frequency, when individuals receive a diagnosis of anorexia, it may be a good medical practice for them to also be screened for depression.
- Feeling unhappy
- A loss of sexual interest
- Anger or irritability
- Diminished appetite
- Trouble sleeping
- A lack of interest in hobbies or activities that were once enjoyed
It is established in the mental health services community that when two disorders co-occur, such as anorexia and depression, treatment for each must be provided simultaneously. A failure to treat one condition can trigger a relapse of the other condition. Further, a lack of treatment for a mental health disorder can exacerbate its symptoms.
Whenever possible, an effective treatment approach is to receive care for both issues within the same program. If such treatment is unavailable, treatment may occur in separate facilities, but it is critical that treatment teams coordinate to provide an integrated recovery plan for both anorexia and depression.
Treatment for Anorexia and Depression
As Mayo Clinic discusses, research-based treatments are available to treat anorexia and depression. When both disorders are being treated, the traditional treatment approaches for each disorder are provided simultaneously. In other words, there is not typically a combined approach (i.e., there usually is not a separate treatment practice for co-occurring anorexia and depression in particular). Attending treatment professionals will work to ensure that medications (if any) taken for each disorder are complementary (hence the need for integrated care). When beneficial, treatment services, such as therapy (psychological counseling), can address both disorders in individual or group sessions. A therapist who has training and experience in both anorexia and depression is typically the optimal treatment provider.
Treatment for anorexia generally includes therapy, medical monitoring, nutrition education, and, in some instances, prescription medications. Medical monitoring helps to ensure the recovering person is working toward a healthy weight and stable physical condition without undermining recovery by re-engaging in anorexic practices.
A residential treatment program can provide 24/7 support and supervision. However, an outpatient program can also be effective as the staff may have ways to discern if the recovering person is following the treatment curriculum, such as via weigh-ins, medical checkups, and during individual counseling sessions.
Therapy approaches to depression that have been shown to be effective include Cognitive Behavioral Therapy (CBT), interpersonal therapy, and psychodynamic therapy. These therapies can be provided in one-on-one and group sessions. Family therapy, which is by its nature group therapy, can be a beneficial supplemental therapy.
The length of therapy depends on an individual’s receptivity to treatment. Although some individuals benefit from short-term therapy, others may have treatment-resistant depression (only detectable after a course of treatment is provided). These individuals are advised to seek maintenance therapy, a longer-term therapy program.
There are over 200 schools of therapy, and recovery centers employ those that best complement their overall treatment philosophy. While various therapeutic approaches may be employed, CBT has been shown to be effective as a research-based approach to treating eating disorders. Many centers implement this approach in both individual and group sessions.
Nutritional education is a key component of care. Depression treatment alone will typically not include this service, but it is essential to the treatment of eating disorders.
- Nutrition basics and understanding the impact of starvation on the body
- The development of regular eating patterns
- Ways to achieve a healthy weight
- How to correct or manage health problems that are the result of malnutrition
- How to develop healthy meal plans
- Ways to avoid relapse to behaviors like dieting or bingeing
There is no medication to cure anorexia. Any medications that are prescribed should only be used under medical supervision as part of a comprehensive treatment program that includes therapy. Research shows that antidepressants can be used in the context of eating disorders; however, their use is determined on a case-by-case basis. Medications may be prescribed to treat health conditions associated with anorexia. For example, medications to address heart problems or digestive problems may be needed.
Traditional treatment for depression includes medications, therapy, and supplemental activities such as exercise. Depression medications span five categories:
- Selective serotonin reuptake inhibitors (SSRIs): the most common type of medication used; includes branded drugs Paxil, Lexapro, and Celexa.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs): a newer generation of antidepressants; branded drugs include Cymbalta, Effexor, and Khedezla
- Tricyclic antidepressants (TCAs): older generation antidepressants; includes brands Elavil, Aventyl, and Adapin
- Monoamine oxidase inhibitors (MAOIs): among the very first antidepressants; branded drugs include Nardil, Marplan, and Parnate
- Additional medications: Not expressly developed for depression treatment but used off-label for to treat the condition: bupropion (Wellbutrin), trazodone (Desyrel), and mirtazapine (Remeron)
Exercise and Balance
Individuals who have a healthy exercise regimen often report the positive effects it has on their mood. For this reason, it should come as no surprise that research shows exercise can improve the mental state of individuals with depression and anxiety. Exercise helps individuals build confidence, release neurochemicals that provide good feelings (endorphins and endocannabinoids), reduces chemicals that can exacerbate depression, and increases body temperature that can stimulate a sense of calm.
Exercise may be included in the recovering person’s treatment curriculum and can also be engaged in after program graduation. It is critical for the recovering person to develop a healthy relationship with exercise, as excessive exercise is a symptom of anorexia. Balance is essential.
Disclaimer: AAC facilities do not treat anorexia. Care can be found at specialty facilities throughout the country.