Depression-Related Increases and Decreases in Appetite: Dissociable Patterns of Aberrant Activity in Reward and Interoceptive Neurocircuitry

Abstract

Objective Appetite and weight changes are common but variable diagnostic markers in major depressive disorder: some depressed individuals manifest increased appetite, while others lose their appetite. Many of the brain regions implicated in appetitive responses to food have also been implicated in depression. It is thus remarkable that there exists no published research comparing the neural responses to food stimuli of depressed patients with increased versus decreased appetites. Method Using functional magnetic resonance imaging we compared brain activity in unmedicated depressed patients with increased or decreased appetite, and healthy control subjects, while viewing photographs of food and non-food objects. We also measured how resting-state functional connectivity related to subjects’ food pleasantness ratings. Results Within putative reward regions, depressed participants with increased appetites exhibited greater hemodynamic activity to food stimuli than both those reporting appetite decreases and healthy control subjects. In contrast, depressed subjects experiencing appetite loss exhibited hypoactivation within a region of the mid-insula implicated in interoception, with no difference observed in this region between healthy subjects and those with depression-related appetite increases. Mid-insula activity was negatively correlated with food pleasantness ratings of depressed participants with increased appetites, and its functional connectivity to reward circuitry was positively correlated with food pleasantness ratings. Conclusions Depression-related increases in appetite are associated with hyperactivation of putative mesocorticolimbic reward circuitry, while depression-related appetite loss is associated with hypoactivation of insular regions that support monitoring the body’s physiological state. Importantly, the interactions among these regions also contribute to individual differences in the depression-related appetite changes.

How the Brain Wants What the Body Needs: The Neural Basis of Positive Alliesthesia

“…The necessity of this pathway for intact drugseeking behavior is supported by translational research in rodents, where temporary inactivation of the interoceptive insula disrupts drug-induced place preference (Contreras et al, 2007) and drug self-administration (Forget et al, 2010), and by clinical research in human patients identifying that insula lesions disrupt addiction (Naqvi et al, 2007). Similarly, in psychiatric disorders such as anorexia and major depression, abnormal interoceptive insula activity is associated with abnormal feeding behavior (Avery et al, 2014;Kerr et al, 2016;Simmons et al, 2016). Taken together, the identification of this relationship between craving and interoceptive activity in the insula may serve to identify specific neural targets for interventions to help humans discontinue unhealthy, but rewarding, behaviors (see Supplementary Materials for limitations and additional discussion).…”

Interoceptive contributions to healthy eating and obesity

“…Importantly, the converse may also be true. Simmons and colleagues observed that obese adults experiencing increased appetite during a major depressive episode rated food cues as more hedonically pleasing and exhibited greater activity in reward neurocircuitry in response to food cues [50]. Critically, however, it was the activity of the dorsal mid insula (bilaterally), and not the brain’s reward circuitry, that was correlated with the subjects’ hedonic ratings for foods.…”

Hubungan Depresi, Asupan, dan Penampilan Makanan dengan Sisa Makan Pagi Pasien Rawat Inap (Studi di Rumah Sakit Islam Jemursari Surabaya)

“…Penelitian ini menjadi salah satu pendukung dari artikel yang ditulis oleh Simmons et al (2015) dengan subjeknya adalah wanita 10 . Hasil dari Simmons et al (2015) menjelaskan bahwa depresi pada seseorang memang mempunyai dua pengaruh terhadap nafsu makan seseorang 10 . Beberapa orang dengan depresi tinggi bisa meningkatkan nafsu makan bahkan bisa menurunkan nafsu makan.…”

“…Beberapa orang dengan depresi tinggi bisa meningkatkan nafsu makan bahkan bisa menurunkan nafsu makan. Hasil akhir dari keduanya akan terlihat bagaimana seseorang itu menyisakan makanan 10 . Pada kondisi depresi, stimulan tekanan hemodinamik otak pada seseorang memiliki hipoaktifasi yang mempengaruhi fisiologis tubuh.…”

“…Penurunan nafsu makan disebabkan karena depresi berasal dari penurunan otak untuk mengintegrasikan sinyal interositeptif visceral aferen. Aktifitas respon lebih rendah di otak bagian anterior dan insula bilateral 10 . Hasil pada tabel 3 menunjukan bahwa asupan energi maupun asupan protein responden paling banyak pada kategori kurang.…”