No abstract

Depression and obesity are very common pathologies. Both cause significant problems of both morbidity and mortality and have decisive impacts not only on the health and well-being of patients, but also on socioeconomic and health expenditure aspects. Many epidemiological studies, clinical studies and meta-analyses support the association between mood disorders and obesity in relationships to different conditions such as the severity of depression, the severity of obesity, gender, socioeconomic status, genetic susceptibility, environmental influences and adverse experiences of childhood. Currently, both depression and obesity are considered pathologies with a high-inflammatory impact; it is believed that several overlapping factors, such as the activation of the cortico-adrenal axis, the exaggerated and prolonged response of the innate immune system and proinflammatory cytokines to stress factors and pathogens—as well as alterations of the intestinal microbiota which promote intestinal permeability—can favor the expression of an increasingly proinflammatory phenotype that can be considered a key and common phenomenon between these two widespread pathologies. The purpose of this literature review is to evaluate the common and interacting mechanisms between depression and obesity.

Bulimia Nervosa (BN) and Binge Eating Disorder (BED) are some of the most common eating disorders (ED) in industrialized societies, characterized by uncontrolled binge eating and self-induced purging or other compensatory behaviours aiming to prevent body weight gain. It has been suggested that reduced serotonergic and noradrenergig tone triggers some of the cognitive and mood disturbances associated with ED. In fact in the active phase of ED the concentration of serotonin and noradrenaline in cerebral fluid is reduced. For these reasons, the pharmacologic treatment of ED consists mainly of selective serotonin reuptake inhibitors (SSRIs) or selective noradrenaline reuptake inhibitors (SNRIs) . At present, the physiologic basis of this disorder are not yet completely understood. In this review we evaluate several randomized controlled trials to compare the efficacy of several SSRIs and SNRIs in patients with a diagnosis of ED as defined by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM IV]) These findings indicate that both SSRIs and SNRIs are well tolerated and reduce effectively the bulimic crisis and purging episodes in patients with ED.

Objectives The purpose of this review is to outline the nosographic characteristics of NES and the most reliable ethiopathogenetic theories in relation to the most recent evidence in the literature. Key findings The night eating syndrome (NES) is a disorder occurring at the stated time, that does not meet the criteria for any specific eating disorder. NES is characterized by a reduced feeding during the day, evening hyperphagia accompanied by frequent nocturnal awakenings associated with conscious episodes of compulsive ingestion of food and abnormal circadian rhythms of food and other neuroendocrine factors. Frequently it is associated with obesity and depressed mood.We highlight the therapeutic possibilities of some drugs, especially selective serotonin re-uptake inhibitors (SSRIs),which reduce the hyperactivity of the serotonin transporter in NES and significantly improve the clinical picture of this disease. Conclusions Night eating syndrome is of importance clinically because of its association with obesity. The recognition and effective treatment of NES may be an increasingly important way to treat a subset of the obese population. Treatment of the syndrome, however, is still in its infancy. One clinical trial has reported efficacy with the SSRI sertraline. Other treatments, such as the anticonvulsant topiramate, phototherapy, and other SSRIs, may also offer future promise. Particularly useful would be studies involving brain scans (magnetic resonance imaging or singlephoton emission computed tomography) of patients with NES compared with the healthy population, to investigate more thoroughly the possible alterations involved in the pathogenesis of NES.

Binge-eating disorder, which is characterized by repeated episodes of uncontrolled eating, is common in obese patients and is often accompanied by comorbid psychiatric disorders, especially depression. In previous studies, selective serotonin reuptake inhibitors have demonstrated efficacy in reducing the frequency of binge eating and addressing comorbid psychiatric disorders, but they have not shown the ability to promote weight loss. Sibutramine, a new serotonin and norepinephrine reuptake inhibitor, has been shown in short- and long-term studies to be effective in promoting and maintaining weight loss in obese patients who have binge-eating disorder. In this randomized, double-blind, placebo-controlled study, the efficacy, safety, and tolerability of sibutramine were evaluated in the treatment of binge-eating disorder in obese patients. Twenty patients were randomly assigned in equal numbers to receive either sibutramine 10 mg/day or placebo for 12 weeks. Assessments were made at baseline and every 2 weeks throughout the study. Binge frequency, defined as the number of days during the previous week that included binge-eating episodes, was the primary outcome measure. By the end of the study, the binge frequency among patients given sibutramine was significantly lower than that among those given placebo. The main adverse events in the sibutramine group were dry mouth and constipation. The findings suggest sibutramine is an effective medication in the treatment of binge-eating disorders and is well tolerated. In addition, it addresses the 3 main goals in the treatment of binge-eating disorder: reducing the frequency of binge eating, promoting and maintaining weight loss, and treating the comorbid psychiatric conditions.