Study after study shows that people with eating disorders are much more likely than others to also have a mood disorder — and major depressive disorder is the most common of these. There is research, in fact, that suggests that 50 to 70 percent of people with eating disorders will suffer at least one depressive episodes during their lifetimes.
What is the link between eating disorders and depression?
Does depression cause disordered eating, or can having an eating disorder make you depressed? This simple question immediately comes up when you learn that depression is so prevalent among people with eating disorders — but the answer is everything but straightforward.
For starters, it's not the same for everyone. While some research has come to the conclusion that depression and eating disorders usually show up around the same time, other research found that about a quarter of people with dual diagnoses of an eating disorder (whether anorexia, bulimia, binge-eating disorder, or EDNOS) and major depressive disorder suffered from depression first.
Mechanisms by which someone could end up with both an eating disorder and depression at the same time could include:
- Shared risk factors. Research has shown that people with eating disorders report a history of stress, trauma (including childhood sexual abuse), low self-esteem, irritability, and anxiety much more often than controls. These factors can also be linked to the development of depression. So in this case, the same underlying risk factors cause two different conditions.
- Depression as the result of an eating disorder. Both being severely malnourished and severely obese can induce depression. Malnourishment can have an intensely depressing effect on the body, while obesity is often linked to feelings of guilt and low self-esteem, while discriminatory social experiences can absolutely contribute to depression as well.
- An eating disorder as a result of depression.
Eating disorders and depression: What's next?
Whether you're reading this because you have anorexia, bulimia, binge-eating disorder, or another eating disorder and are feeling depressed, or you're here for someone you care about, here's a summary of the symptoms of depression:
- The first one is a "depressed mood", which more or less speaks for itself.
- Diminished interest, or a complete loss of interest, in daily activities and activities that used to be meaningful.
- Insomnia or oversleeping.
- Fatigue or loss of energy.
- A physical slowing down or speeding up.
- Loss of appetite (associated with weight loss) or increased appetite (and weight gain).
- A negative self-image, particularly experiencing inappropriate guilt and worthlessness.
- Being unable to concentrate and having trouble making decisions.
- Repeated thoughts about death or suicide (not just fearing death).
Some of these symptoms can also result directly from the eating disorder itself, so it is up to the diagnosing doctor to differentiate between the two.
How is depression treated in someone who already has an eating disorder?
As with depressed people who are not also facing an eating disorder, the treatment options include:
- Antidepressant therapy — particularly fluoxetine (Prozac, Sarafem), which was also FDA-approved specifically for the treatment of bulimia nervosa.
- Talk therapy, which has been shown to help people with eating disorders as well as depression. This can include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. Which approach is right for you will depend on the underlying issues you may be needing to work on.
- A combination of both.
In some cases, recovering from the eating disorder a patient suffered from — combined with improved nutritional quality and a halthier weight — will alleviate depression symptoms as well.
One study revealed, however, that though 70 percent of their participants with both an eating disorder and major depressive disorder recoevred, a high number of patients also relapsed, finding themselves depressed again. It is, therefore, important for people to continue treatment even after their symptoms improve, to reduce the risk of recurrence.
The interplay between eating disorders and depression is complex, and still little understood, although it is beyond clear that rates of depression are higher in people with any kind of eating disorder. If you have already been diagnosed with an eating disorder — or are aware you have one — and are now feeling depressed, you are far from alione. It is important to talk to your primary care provider or a psychologist as soon as possible, as this is what will allow you to access antidepressant and talk therapy. It may not feel like it now, but it is possible to recover.