Dieting your way to an eating disorder

Hannah - Closing the show, have you ever been on a diet?  If so, notice feeling a bit ratty, anxious, low and then start to fixate on food?  It certainly happened to me. 

Georgia Mills spent some time with Philip Cowen, Professor of Psychopharmacology, who was awarded the British Association of Psychopharmacology Lifetime Achievement Award. He whetted his academic appetite by uncovering the dieting brain. Like Lesley, he has also worked extensively studying depression.  He starts off by discussing his views and hopes for depression treatment in the future.

Philip -   I think people talk more about having been depressed and that's always very helpful because I think you can feel very alone with it.  And to know that others have felt the same have suffered and have improved can be very heartening.  At the same time, I think there's been quite a lot of publicity about the negative effects of antidepressant treatment particularly in medications and that's been hard for some patients.  One hears various claims about them such as antidepressants don't work or they might be addictive.  I think more recently, they do more harm than good.  When people hear that, this obviously can be distressing if you've taken an antidepressant and it's helped you.  I think we understand a lot more about neurocircuitry.  We understand more about the brain basis of depression.  I'd have to say, the treatments haven't changed all that much and that's been rather a disappointment.

Georgia -   What would you hope to change now in the treatment of depression?

Philip -   I would hope that in understanding the brain basis and the neurobase of depression might lead to better treatments.  Actually, perhaps more in the psychotherapeutic line and in the drug line, and the way that one might be able to train different parts of the brain to respond in a more appropriate or less distressing way to environmental input.  So, in a way, it's like more traditional psychotherapies, but guided by modern neuroscience.

Georgia -   So, would you advocate a step away from chemical treatments and drugs?

Philip -   I think that will always be useful for patients who don't respond to psychological methods.  But I think there's a general tendency to say that psychological treatment should be first line where they're available and I would support that.  At this meeting, there's been a lot of work discussed on the role of inflammation in depression.  That's a very interesting idea and it gives rise to some potentially new treatments which might help those patients who don't respond very well to what we have now.  So, I find that exciting.

Georgia -   So, what is inflammation?

Philip -   Well, it's a process which is part of many medical conditions, but it hasn't traditionally been linked with depression which is seen pretty much as a psychological disorder or a brain disorder.  But it's now clear that inflammation can affect the brain and it certainly can affect mood.  And so, this is a good line to work on if you're trying to come up with some new treatments.

Georgia -   And as well as depression, you've worked on eating disorders and the causes of these.  Can you tell us a bit about that?

Philip -   Well, my work there was carried out with my colleagues Chris Fairburn, and Guy Goodwin and we were interested in the effects of dieting because eating disorder start as normal dieting which gets out of control.  And what we looked at was the effect of dieting on a brain neurotransmitter called serotonin.  Serotonin is very involved in mood and appetite.  And we made a connection between dieting and serotonin effects.  That gave an explanation as to why in some people, dieting can lead to eating disorders by acting as a kind of trigger through its effects on serotonin.  Dieting is a statistically normal behaviour even though it may not be particularly wise if people overdo it.  without meaning to, if you lower brain serotonin levels through dieting, that can lead to lower mood and more compulsive behaviour.  So, the dieting really gets a grip on you and it's very hard to stop.

Georgia -   And the treatment of these, would you recommend psychotherapies?

Philip -   I think they're the main stay for all kinds of eating disorders and it really consists of going back to a normal diet and retraining yourself to eat in an appropriate manner.  Often underlying eating disorders are rather negative use, people have of themselves and they need to be worked on as well which again, I think is best done psychologically.  Over my career, the big change is being this idea that the brain has some plasticity, that it can change, it can learn, and that gives enormous encouragement for thinking of new psychological treatments to help people who spent long periods in their lives feeling pretty terrible.

Hannah -   So, we can all feel optimistic about our flexible brains.  Well unfortunately, that's all we have time for in this episode.  Thanks to all those in the programme, Philip Cowen, Lesley Cousins, Michael Bloomfield and Kristen Brennand.  This is a Special Naked Neuroscience episode reporting from the British Association of Psychopharmacology 2014 Meeting in Cambridge. 

See you next month to open our minds.