Anorexia study investigates benefits of antidepressants

It is estimated that 8 million Americans have an eating disorder. Anorexia nervosa, specifically, is the third most common chronic illness among adolescents, according to the National Eating Disorder Information Centre.

"We know it accounts for more deaths than any other psychiatric illness, killing up to six out of 100 affected individuals," says Karen Daley, CGSON '09.

For the Connell School of Nursing (CSON), this June marked the one-year anniversary of an ongoing study on anorexia nervosa conducted by Barbara Wolfe, a nurse researcher and professor in CSON.

The study, Serotonin Function in Anorexia Nervosa, aims to understand the neurobiology of anorexia in relation to serotonin levels. The researchers hope to make a connection with serotonin levels that will lead to a better understanding of the disorder and eventually a cure.

"We know that normal regulation of serotonin, a neurotransmitter tied to mood, appetite, and impulse control, is disrupted in anorexia," says Daley.

Unlike with bulimia nervosa, however, controlled trials of pharmacological interventions, including selective serotonin reuptake inhibitors (SSRIs), have demonstrated very limited effectiveness in the treatment of anorexia nervosa.

"It is not clear why patients with anorexia don't respond as well to SSRIs during active illness when serotonin function is known to be unregulated," says Daley, which is something the study hopes to learn.

Experts do know that brain serotonin is largely dependent on the amino acid tryptophan, which comes from food, particularly poultry and dairy.

"Dr. Wolfe is hypothesizing that the ability of the SSRI fluoxetine [an antidepressant] to augment serotonin function is impaired in persons with anorexia due to nutritional deficits that occur as a result of extreme dieting behaviors. She is also testing whether administration of 5-hydroxytryptophan (5-HTP), the amino acid precursor for serotonin synthesis [what tryptophan converts to before changing into serotonin], in combination with fluoxetine, provides a potential strategy for restoring serotonergic responsiveness," says Daley.

Essentially, this means that Wolfe is testing whether using an antidepressant can improve serotonin function, which is decreased in people with anorexia because of a lack of proper nutrition, and hopes to find ways to increase the responsiveness of seratonin. It is possible that people who suffer from anorexia have difficulty regulating serotonin in the body, and that if this could be corrected, the person might be able to recover from the disease.

After tests are conducted with these amino acids, participants are given a frozen yogurt snack to test their level of satiety and hunger. The results show whether the patient reacts to the potential increase in serotonin - if the subject is hungry, this means that serotonin levels have increased.

The results of this study are important because of the mental and social weight attached to anorexia.

"The disease can be associated with so many social, physiologic, and psychological factors, and can be very resistant to treatment," says Daley. "Dr. Wolfe is hoping that findings from her study will help unravel a number of the complex issues thought to underlie some of the disabling behaviors associated with anorexia."

The study is entering its second year, and up to two years more are needed to finish the study, says Wolfe. Once the study is complete, she will gather all the information collected and analyze the data, a process which will take another five to six months.

"It is hoped that study findings will contribute to a better understanding of some of the neurobiological factors that make anorexia so refractory to treatment. It is also hoped that results of this study will help clarify the usefulness of serotonin precursor augmentation as a possible new treatment," says Daley.

The immediate need for help with anorexia on campus is largely provided by the Women's Resource Center on campus, which provides walk-in service, recommendations for counseling, and programs such as HOPE: Healthy Options for the Pressures of Eating, which is a discussion group that meets every week. Though those affected by anorexia are mostly adolescent girls and young adult women, it also affects males and older females, making it relevant for many on campus.

"It is a severe disease that is plaguing a fair percent of our study body, especially among girls. Body image is such a main concern for kids our age. Sensitivity must be brought to the situation because it is not just a physical disorder but also a mental one," says Jamie Buller, CSON '09.

Anorexia is a significant problem for the college population, to the extent that virtually everyone is touched by it either through knowing of someone who suffers from it or through a more direct connection to a friend or family member," Lisa Cuklanz, communication professor. "It should be considered at the extreme end of a continuum that includes disordered attitudes toward eating and is exacerbated by a beauty culture emphasizing extreme thinness as the ideal for women."

Many recognize the pressing need for an explanation of this disease.

"It is easy to put anorexia on the back burner when compared to illnesses like schizophrenia or bipolarity. But its prevalence in society, especially at our age, is so clear," says Maryann Odusanya, A&S '08.

Odusanya is a psychology major who joined the study team last year out of personal concern. She does phone screenings on campus to get preliminary information about patients and occasionally goes to the Beth Israel Clinic to watch the study on site.

"It is very rewarding to get to talk to people when I do go to the hospital. It makes the research world so real. I have always been interested in research but it is one thing when you are in a statistics class and another when you are at a hospital with ill patients," says Odusanya.