title: Ghrelin concentrations and cardiac vagal tone are decreased after pharmacologic and cognitive-behavioral treatment in patients with bulimia nervosa.
abstract: Patients with bulimia nervosa (BN) have bulimic and depressive symptoms, which have been associated with abnormalities in the neuroendocrine and vagal systems. Subjects included twenty-four female drug-free outpatients with BN that were selected from patients seeking treatment for eating behavior in our hospital along with twenty-five age-matched healthy females who served as controls. We investigated ghrelin and leptin levels, cardiac vagal tone and sympathovagal balance, frequency of sets of binge-eating and vomiting episodes per week and the Profile of Mood States (POMS) depression scale in BN before and after a 16-week administration of the serotonin selective reuptake inhibitor (SSRI) paroxetine combined with cognitive-behavioral therapy. Compared to controls, the BN group had higher ghrelin levels and resting cardiac vagal tone, and lower leptin levels and resting cardiac sympathovagal balance before treatment, although there was a significant difference between the two groups for the body mass index (BMI). The elevated ghrelin levels (301.7 +/- 18.9 pmol/l, mean +/- SEM vs. 202.8 +/- 15.6 pmol/l, P < 0.01), cardiac vagal tone (2246.4 +/- 335.5 ms(2) vs. 1128.5 +/- 193.3 ms(2), P < 0.01), frequency of sets of binge-eating and purging episodes and T scores for the POMS depression scale were all significantly decreased after treatment despite similar BMI, percent body fat and leptin levels. In close association with cardiac vagal function and ghrelin recoveries, abnormal eating behavior and depressive symptoms improved, indicating the usefulness of these indexes in the assessment of clinical condition and therapeutic efficacy in BN.
authors.affiliation: Department of Psychosomatic Medicine, Respiratory and Stress Care Center, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan. muneki@m3.kufm.kagoshima-u.ac.jp
authors.forename: Muneki
authors.initials: M
authors.lastname: Tanaka
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nakahara
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Muranaga
authors.forename: Shinya
authors.initials: S
authors.lastname: Kojima
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yasuhara
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ueno
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Nakazato
authors.forename: Akio
authors.initials: A
authors.lastname: Inui
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D001823:Body Composition / Q000187:drug effects / Q000502:physiology; D015992:Body Mass Index; D002032:Bulimia / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D005260:Female; D054439:Ghrelin; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D020738:Leptin / Q000097:blood; D017374:Paroxetine / Q000627:therapeutic use; D036361:Peptide Hormones / Q000097:blood*; D011569:Psychiatric Status Rating Scales; D014630:Vagus Nerve / Q000503:physiopathology*
chemical_list: D018687:Antidepressive Agents, Second-Generation; D054439:Ghrelin; D020738:Leptin; D036361:Peptide Hormones; D017374:Paroxetine