Depression and eating disorders: treatment and course.
BACKGROUND
We examined the course of major depressive disorder (MDD) and predictors of MDD recovery and relapse in a longitudinal sample of women with eating disorders (ED).


METHODS
246 Boston-area women with DSM-IV anorexia nervosa-restricting (ANR; n=51), AN-binge/purge (ANBP; n=85), and bulimia nervosa (BN; n=110) were recruited between 1987 and 1991 and interviewed using the Eating Disorders Longitudinal Interval Follow-up Evaluation (LIFE-EAT-II) every 6-12 months for up to 12 years. 100 participants had MDD at study intake and 45 developed MDD during the study. Psychological functioning and treatment were assessed.


RESULTS
Times to MDD onset (1 week-4.3 years), recovery (8 weeks-8.7 years), and relapse (1 week-5.2 years) varied. 70% recovered from MDD, but 65% subsequently relapsed. ANR patients were significantly less likely to recover from MDD than ANBP patients (p=0.029). Better psychological functioning and history of MDD were associated with higher chance of MDD recovery. Higher baseline depressive severity and full recovery from ED were associated with greater likelihood of MDD relapse; increased weight loss was somewhat protective. Adequate antidepressant treatment was given to 72% of patients with MDD and generally continued after MDD recovery. Time on antidepressants did not predict MDD recovery (p=0.27) or relapse (p=0.26).


CONCLUSIONS
Small ED diagnostic subgroups; lack of non-ED control group.


CONCLUSIONS
The course of MDD in EDs is protracted; MDD recovery may depend on ED type. Antidepressants did not impact likelihood of MDD recovery, nor protect against relapse, which may impact on treatment strategies for comorbid MDD and EDs.
Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA. dmischoulon@partners.org
David
D
Mischoulon
Kamryn T
KT
Eddy
Aparna
A
Keshaviah
Diana
D
Dinescu
Stephanie L
SL
Ross
Andrea E
AE
Kass
Debra L
DL
Franko
David B
DB
Herzog
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology; D000928:Antidepressive Agents / Q000627:therapeutic use*; D056912:Binge-Eating Disorder / Q000523:psychology; D001900:Boston / Q000453:epidemiology; D052018:Bulimia Nervosa / Q000523:psychology; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D001068:Feeding and Eating Disorders / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011379:Prognosis; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000928:Antidepressive Agents