Postprandial Oxytocin Secretion Is Associated With Severity of Anxiety and Depressive Symptoms in Anorexia Nervosa

Abstract

Objective Anorexia nervosa, a psychiatric disorder characterized by self-induced starvation, is associated with endocrine dysfunction and comorbid anxiety and depression. Animal data suggest that oxytocin may have anxiolytic and antidepressant effects. We have reported increased postprandial oxytocin levels in women with active anorexia nervosa (AN), and decreased levels in weight-recovered women with anorexia nervosa (ANWR) compared to healthy controls (HC). A meal may represent a significant source of stress in patients with disordered eating. We therefore investigated the association between post-prandial oxytocin secretion and symptoms of anxiety and depression in anorexia nervosa. Method We performed a cross-sectional study of 35 women (13 AN, 9 ANWR and 13 HC). Serum oxytocin and cortisol and plasma leptin levels were measured fasting and 30, 60, and 120min after a standardized mixed meal. The area under the curve (AUC), and for oxytocin, postprandial nadir and peak levels were determined. Anxiety and depressive symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory II (BDI-II). Results In women with anorexia nervosa, oxytocin AUC and post-prandial nadir and peak levels were positively associated with STAI scores. Oxytocin AUC and nadir levels were positively associated with BDI-II scores. After controlling for cortisol AUC, most relationships remained significant. After controlling for leptin AUC, all of the relationships remained significant. Oxytocin secretion explained up to 51% of the variance in STAI trait and 24% of BDI-II scores. Conclusions Abnormal post-prandial oxytocin secretion in women with anorexia nervosa is associated with increased symptoms of anxiety and depression. This may represent an adaptive response of oxytocin secretion to food-related symptoms of anxiety and depression.

The endocrine manifestations of anorexia nervosa: mechanisms and management

“…1). Although nocturnal levels of serum oxytocin are lower in women with anorexia nervosa than in normal-weight individuals 84 , postprandial serum oxytocin levels are higher in women with active and weight-recovered anorexia nervosa than in normal-weight women 85 . One potential explanation for this apparent contradiction is an inverse association between central and peripheral oxytocin levels 86 , such that increased postprandial levels of serum oxytocin indicate an adaptive response to decreased postprandial central oxytocinergic satiety signalling 85 .…”

“…Anxiety and depression, as well as eating disorder psychopathology, are associated with dysregulation of hormones, including oestrogen, androgen, cortisol, leptin, PYY and oxytocin levels 56,85,103,160–162 . Oestrogen deficiency might negatively affect mood and anxiety 161,163 .…”

“…Measures of eating disorder psychopathology have been positively associated with serum cortisol and PYY levels independent of BMI 103 , and negatively associated with elevated levels of serum leptin 162 , in women with anorexia nervosa. Postprandial oxytocin levels are also associated with higher eating disorder psychopathology, anxiety and depression scores in anorexia nervosa 85,167 , possibly as an adaptive response to cope with the stress of food intake as oxytocin has known anxiolytic and antidepressant effects 167 .…”

The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects

“…Oxytocin is a neuromodulatory prosocial hormone that is released by the hypothalamus and stored in the pituitary gland. The literature is discrepant whether this hormone is increased, decreased, or normal in AN [165, 166], and one study found that plasma oxytocin levels predicted anxiety and depression ratings after a meal [167]. A series of double-blind studies from the same group indicated that oxytocin reduced attention bias to disgust in both AN and control groups, suggesting that in AN, oxytocin reduced attention bias to food and body-related stimuli but had no effect on emotion recognition or food intake [168-170].…”

The impact of meal consumption on emotion among individuals with eating disorders

“…Current literature generally appears to suggest that individuals with AN and BN evidence elevated post-meal negative affect. Recent research has suggested that eating a meal serves as a stressor that can elicit anxiety and depressive symptoms for individuals with AN [14]. Furthermore, past studies indicated that individuals with AN or BN reported elevated negative affect when asked to think about eating a meal [15][16][17].…”