The Trajectory from Mood to Obesity.

Purpose Of Review: To describe and explain the relationships between mood disturbances and the development of obesity.

Recent Findings: That depression, anxiety, PTSD, or severe stresses can promote obesity as a side-effect of the drugs used to treat them, or through "carbohydrate craving" to enhance brain serotonin synthesis and alleviate dysphoria by consuming foods that are rich in both carbohydrates and fats. That seasonal affective disorder and severe PMS can independently cause patients to overconsume foods rich in both carbohydrates and fats.

Report of two double-blind randomized placebo-controlled pilot studies of a carbohydrate-rich nutrient mixture for treatment of seasonal affective disorder (SAD).

We investigated a carbohydrate-rich nutrient-drink mix for treatment of seasonal affective disorder (SAD). This mixture may contribute to brain serotonin synthesis, potentially exerting an antidepressant effect and controlling carbohydrate cravings. Two successive double-blind placebo-controlled studies were performed.

Weight loss in overweight patients maintained on atypical antipsychotic agents.

Background: Weight gain and associated medical morbidity offset the reduction of extrapyramidal side effects associated with atypical antipsychotics. Efforts to control weight in antipsychotic-treated patients have yielded limited success.

Methods: We studied the impact of an intensive 24-week program of diet, exercise, and counseling in 17 chronically psychotic patients (10 women, seven men) who entered at high average body weight (105.

Effects of normal meals rich in carbohydrates or proteins on plasma tryptophan and tyrosine ratios.

Background: The delivery of circulating tryptophan to the brain and its conversion to serotonin vary directly with plasma concentrations of tryptophan and inversely with those of other large neutral amino acids (LNAAs). Although carbohydrate-rich, protein-free formula diets have been shown to elevate, and high-protein diets to depress, the tryptophan-LNAA ratio, few data are available about this ratio's responses to actual meals.

Objective: We determined whether carbohydrate-rich or protein-rich breakfasts, such as those Americans normally eat, produce substantial differences in the plasma tryptophan-LNAA ratio and in the corresponding ratio for tyrosine, the precursor of brain dopamine and norepinephrine.

The effect of a novel dietary intervention on weight loss in psychotropic drug-induced obesity.

Weight gain associated with the use of psychotropic drugs may be related to their blockade of serotonin receptors which mediate satiety. Obese individuals whose weight gain followed psychotropic drug use, or control nondrug-treated obese subjects, were treated with a 12-week weight loss program that included a carbohydrate-rich, protein-poor beverage thought to increase brain serotonin.The 38 psychotropic drug treated females lost slightly more weight than their 60 nondrug-treated controls, ie, 13.

Impact of hormone replacement therapy on the body mass and fat compositions of menopausal women: a cross-sectional study.

Objective: The purpose of the study was to compare the body mass and fat compositions of menopausal women who were taking conventional doses of hormone replacement therapy (HRT) with that of menopausal women who were not taking any hormones.

Design: The body fat composition of 169 healthy postmenopausal women was measured using a noninvasive handheld machine, the Electrolipograph (BioAnalogics ELG, Beaverton, OR, USA). Impedance to electrical flow in tissues is lower with increasing water content of the tissue.

Aspartame: neuropsychologic and neurophysiologic evaluation of acute and chronic effects.

Background: Neurobehavioral symptoms have been reported anecdotally with aspartame.

Objective: This study sought to determine whether aspartame can disrupt cognitive, neurophysiologic, or behavioral functioning in normal individuals.

Design: Forty-eight healthy volunteers completed a randomized, double-blind, placebo-controlled, crossover study.

Efficacies of dexfenfluramine and fluoxetine in preventing weight gain after smoking cessation.

We tested whether 14 wk of dexfenfluramine (30 mg) or fluoxetine (40 mg) treatment would prevent weight gain after subjects quit smoking. Normal-weight women (n = 144) were randomly assigned to drug or placebo on a double-blind basis for 2 wk before quitting smoking and 12 wk thereafter. The fluoxetine group had more dropouts (28/49, 57.

Brain serotonin, carbohydrate-craving, obesity and depression.

Serotonin-releasing brain neurons are unique in that the amount of neurotransmitter they release is normally controlled by food intake: Carbohydrate consumption--acting via insulin secretion and the "plasma tryptophan ratio"--increases serotonin release; protein intake lacks this effect. This ability of neurons to couple neuronal signaling properties to food consumption is a link in the feedback mechanism that normally keeps carbohydrate and protein intakes more or less constant. However, serotonin release is also involved in such functions as sleep onset, pain sensitivity, blood pressure regulation, and control of the mood.

Effects of hormone replacement therapy on weight, body composition, fat distribution, and food intake in early postmenopausal women: a prospective study.

Objective: To evaluate the effects of hormone replacement therapy (HRT) on body weight and composition, fat distribution, and food intake in women entering the climacteric.

Design: Prospective clinical study.

Setting: Outpatient menopause clinic at a tertiary medical center.

The effect of a carbohydrate-rich beverage on mood, appetite, and cognitive function in women with premenstrual syndrome.

Objective: To test the efficacy of a specially-formulated, carbohydrate-rich beverage (one known to increase the serum ratio of tryptophan to other large neutral amino acids) on the mood, cognitive, and appetitive disturbances of premenstrual syndrome (PMS).

Methods: Twenty-four women with confirmed PMS were enrolled in a double-blind, crossover study to test the efficacy of the specially-formulated beverage compared with two other isocaloric products on PMS symptoms. The study was conducted over three menstrual cycles preceded by a 1-month placebo run-in.

Aberrant snacking patterns and eating disorders in patients with obsessive compulsive disorder.

Background: Appetitive symptoms, particularly carbohydrate craving, have been shown to occur in patients whose conditions responded to treatment with drugs that enhance serotonin-mediated neurotransmission. This suggested that patients with obsessive compulsive disorder (OCD) who also frequently respond to serotonergic drugs also might have similar distributions of appetitive and eating patterns.

Method: A survey study of 170 OCD patients and 920 controls was conducted using a questionnaire that inquired about snacking behavior, including food preference, mood changes after eating, and previous diagnosis of eating disorders.

Dexfenfluramine, fluoxetine, and weight loss among female carbohydrate cravers.

The consumption of excess calories as carbohydrates (CHO)-rich, protein-poor snacks characterizes the overeating of obese CHO cravers, premenstrual women, patients with Seasonal Affective Disorder, and former smokers. This specific appetite for CHOs may involve brain serotonin, as the synthesis and release of this neurotransmitter can increase following consumption of CHO-rich foods. To examine whether weight loss produced by serotoninergic drugs involves a selective reduction in CHO intake, obese females who consumed at least 30% of their daily calories from CHO-rich snacks were treated with dexfenfluramine ([DF] 15 mg b.

Depression and weight gain: the serotonin connection.

The inability to control food intake and to engage in consistent exercise may account for repetitive episodes of weight gain. Many individuals who fail to maintain a normal weight may be susceptible to daily, monthly or seasonal perturbations in mood which result in an excessive intake of carbohydrate-rich foods and resistance to engaging in physical activity. Brain serotonin appears to be involved in these disturbances of mood and appetite; recent studies have shown that dietary and pharmacological interventions which increase serotoninergic activity normalize food intake and diminish depressed mood.

A balanced carbohydrate: protein diet in the management of Parkinson's disease.

Although restricting dietary protein is a proposed adjunct to treating Parkinson's disease (PD), the effect of carbohydrate consumption is unknown. We measured plasma levodopa and large neutral amino acid (LNAA) levels in nine PD patients treated with carbidopa/levodopa and different isocaloric meals containing high protein-low carbohydrate, low protein-high carbohydrate, and balanced 5:1 carbohydrate:protein mixtures. We found that levodopa levels increased significantly regardless of the type of diet, but that plasma LNAA levels varied less and motor performance was superior after the balanced diet than after the other two meals.

Weight gain and withdrawal symptoms after smoking cessation: a preventive intervention using d-fenfluramine.

Directly measured food intake in 31 overweight female smokers to test whether (a) calorie and carbohydrate intakes increase after smoking cessation and (b) double-blind d-fenfluramine (30 mg), a serotonin-releasing drug, suppresses weight gain, overeating, and dysphoric mood associated with stopping smoking. Placebo-treated patients grew dysphoric after smoking withdrawal and ate 300 kcal/day more from 2 to 28 days after, showing a 3.5-lb weight gain.

d-Fenfluramine suppresses the increased calorie and carbohydrate intakes and improves the mood of women with premenstrual depression.

The ability of d-fenfluramine, a drug that releases brain serotonin and blocks its reuptake, to relieve premenstrual depression and excessive calorie and carbohydrate intakes was examined in 17 women with premenstrual syndrome. Subjects received d-fenfluramine (15 mg twice daily) or placebo, in random order, during the luteal phases of six menstrual cycles; ie, for three control and three treatment cycles each. Behavior was assessed with the Hamilton Rating Scale for Depression and its Addendum, and intakes of calories and nutrients were measured by allowing subjects unlimited access to isocaloric meal and snack foods rich in carbohydrates or protein.

Carbohydrate craving. Relationship between carbohydrate intake and disorders of mood.

Common to repetitive episodes of weight gain or failures to succeed on weight loss regimens is the excessive consumption of carbohydrate-rich foods in association with dysphoria. The brain neurotransmitter, serotonin, seems to be involved in the abnormal regulation of mood and food intake that underlies diet failures or weight gain in individuals who suffer from carbohydrate craving obesity (CCO), premenstrual syndrome (PMS) and seasonal affective disorder (SAD). All 3 syndromes are characterized by episodic bouts of increased carbohydrate consumption and depressed mood.

Effect of nutrient intake on premenstrual depression.

We examined the occurrence and coincidence of depressed mood and excessive carbohydrate intake in 19 patients who claimed to suffer from severe premenstrual syndrome and in nine control subjects, all as inpatients, during the early follicular and late luteal phases of their menstrual cycles. Mood was assessed with the Hamilton Depression Scale and an addendum that evaluated fatigue, sociability, appetite, and carbohydrate craving. Calorie and nutrient intakes were measured directly.

Treatment of seasonal depression with d-fenfluramine.

Eighteen patients with seasonal affective disorder (SAD) participated in a double-blind, placebo-controlled crossover study in 1986-1987. Each received, in random order, d-fenfluramine (15 mg p.o.

Circadian rhythms of activity in healthy young and elderly humans.

Patterns of activity of healthy adult humans were monitored in a controlled environment for several days using a wrist-mounted ambulatory activity meter. Subjects were 15 young males, 14 young females, 17 elderly males and 23 elderly females. Substantial differences in the absolute levels and patterns of daily rest and activity across age groups were observed.