Abstract
Orthorexia nervosa (ON) is a recently proposed eating disordered behaviour characterized by an obsessional or exaggerated fixation on healthy eating. The published literature is scarce regarding its classification, clinical presentation, management and long-term outcomes. Herein, we present the clinical and follow-up findings of an 18-year-old woman with ON comorbid with depression, successfully treated with mirtazapine. The patient had a 12-month history of obsessional behaviours for “healthy food”, characterized by suppression of sugar and fat from her diet, tightly counted meal calorie content, eating only self-made meals, avoidance of eating in public, unacceptance of other person’s opinions on diet, social isolation and a weight loss of 15 kg (body mass index of 16.2 kg/m2). A score of 19-points was initially obtained on the ORTO-15 questionnaire, suggesting the presence of orthorexic tendencies and behaviours. The patient also reported a 1-month history of depressed mood, anxiety, anhedonia, fatigue, insomnia with early morning waking, leading to the presumptive diagnosis of ON with comorbid depression. Treatment with mirtazapine for 11 months resulted in the remission of the disordered eating behaviour, a sustained regain of weight, a score of 41-points on the ORTO-15, and to the resolution of depressive symptomatology (including insomnia). To our knowledge, this is the first description of ON with comorbid depression successfully treated with mirtazapine. This case highlights the possible usefulness of mirtazapine as a treatment option for patients with ON. However, randomized controlled studies are warranted to confirm the current findings.
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References
Cuzzolaro M, Donini LM (2016) Orthorexia nervosa by proxy? Eat Weight Disord 21(4):549–551. https://doi.org/10.1007/s40519-016-0310-8
Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 21:11–17. https://doi.org/10.1016/j.eatbeh.2015.12.006
Moroze RM, Dunn TM, Craig Holland J, Yager J, Weintraub P (2015) Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics 56(4):397–403. https://doi.org/10.1016/j.psym.2014.03.003
Luck-Sikorski C, Jung F, Schlosser K, Riedel-Heller SG (2018) Is orthorexic behavior common in the general public? A large representative study in Germany. Eat Weight Disord. https://doi.org/10.1007/s40519-018-0502-5
Dell’Osso L, Carpita B, Muti D, Cremone IM, Massimetti G, Diadema E, Gesi C, Carmassi C (2018) Prevalence and characteristics of orthorexia nervosa in a sample of university students in Italy. Eat Weight Disord 23(1):55–65. https://doi.org/10.1007/s40519-017-0460-3
Alam A, Voronovich Z, Carley JA (2013) A review of therapeutic uses of mirtazapine in psychiatric and medical conditions. Prim Care Companion CNS Disord. https://doi.org/10.4088/PCC.13r01525
Stahl SM, Muntner N (2013) Stahl’s essential psychopharmacology: neuroscientific basis and practical applications. In: Stahl SM, Muntner N (eds), 4th edn. Cambridge University Press, Cambridge
Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10(2):e28–e32
American Psychiatric Association, DSM-5 Task Force (2013) Diagnostic and statistical manual of mental disorders: DSM-5™, 5th edn. American Psychiatric Publishing, Inc., Arlington, VA
Lopes R, Melo R, Curral R, Coelho R, Roma-Torres A (2014) A case of choking phobia: towards a conceptual approach. Eat Weight Disord 19(1):125–131. https://doi.org/10.1007/s40519-013-0048-5
Saddichha S, Babu GN, Chandra P (2012) Orthorexia nervosa presenting as prodrome of schizophrenia. Schizophr Res 134(1):110. https://doi.org/10.1016/j.schres.2011.10.017
Safer DL, Darcy AM, Lock J (2011) Use of mirtazapine in an adult with refractory anorexia nervosa and comorbid depression: a case report. Int J Eat Disord 44(2):178–181. https://doi.org/10.1002/eat.20793
Mrakotsky C, Masek B, Biederman J, Raches D, Hsin O, Forbes P, de Moor C, DeMaso DR, Gonzalez-Heydrich J (2008) Prospective open-label pilot trial of mirtazapine in children and adolescents with social phobia. J Anxiety Disord 22(1):88–97. https://doi.org/10.1016/j.janxdis.2007.01.005
Cipriani A, Zhou X, Del Giovane C, Hetrick SE, Qin B, Whittington C, Coghill D, Zhang Y, Hazell P, Leucht S, Cuijpers P, Pu J, Cohen D, Ravindran AV, Liu Y, Michael KD, Yang L, Liu L, Xie P (2016) Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet 388(10047):881–890. https://doi.org/10.1016/S0140-6736(16)30385-3
Mocking RJ, Harmsen I, Assies J, Koeter MW, Ruhe HG, Schene AH (2016) Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Transl Psychiatry 6:e756. https://doi.org/10.1038/tp.2016.29
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Lopes, R., Melo, R. & Dias Pereira, B. Orthorexia nervosa and comorbid depression successfully treated with mirtazapine: a case report. Eat Weight Disord 25, 163–167 (2020). https://doi.org/10.1007/s40519-018-0539-5
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DOI: https://doi.org/10.1007/s40519-018-0539-5