The Link Between Depression & Other Mental Illness (cont.)

For people suffering with bulimia nervosa, large amounts of food are eaten all at once and then vomited. The vomiting is triggered by a fear of weight gain or stomach pain. People with bulimia also use laxatives, diuretics and vigorous exercise to purge themselves. In order for a person to be diagnosed with bulimia, this behavior must occur at least twice a week for three months in a row. Although people with bulimia are often underweight, they may also appear to have a normal body weight. Common symptoms of bulimia include:

• Fasting
• Secrecy about eating behaviors
• Frequent bathroom use after eating
• Depression and mood swings
• Chewing and spitting out foods
• Preoccupation with food and weight
• Irregular menstrual periods
• Drug or alcohol abuse
• Feelings of anxiousness
• Intense feelings of guilt or shame

Because of frequent vomiting, people with bulimia expose themselves to higher than average amounts of stomach acid, which over time can lead to physical problems. These may include a sore or bleeding throat, stomach problems, heartburn, bloating, swollen glands in the cheeks and face and tooth decay. Though no one cause exists for bulimia, it is often a reaction to stress and anxiety. It is estimated bulimia will affect up to 4.2% of females at some point in their lives.

For patients with eating disorders, counseling is often an effective treatment. Counseling teaches patients how to free themselves from destructive patterns of thinking and behaving as well as re-evaluate their relationship with food. Medicines such as antidepressants may also be prescribed.

Substance Abuse

Substance abuse is the use of drugs or alcohol to the point of social, occupational or physical harm. Millions of Americans abuse drugs or alcohol for a variety of reasons -- including as a coping mechanism to stress and anxiety or due to biological factors, such as a genetic tendency. Commonly associated with depression, substance abuse may include some of the following symptoms:

• The need to increase the amounts of a substance in order to become intoxicated or a diminished effect from continued use of the same amount.
• Withdrawal symptoms such as nausea, shaking, insomnia, agitation, and sweating following a reduction in the amount of a substance taken.
• In order to ease withdrawal symptoms, a person takes more of the substance.
• Despite a person's efforts, discontinuing use of the substance is not possible.
• Large amounts of time and effort are spent trying to get the substance or recover from its use.
• The amount of a substance is increased over time, beyond any amount originally intended.
• The substance is still used despite the knowledge of its harmful effects on a person's physical and mental condition.
• Social, recreational and work-related activities are given up or reduced because of substance use.

In treating patients with substance abuse, the approach may vary from person to person. Some respond well to one-on-one counseling, others to group counseling and support groups. Antidepressant medicines -- in combination with education to help patients address and conquer the emotions that cause them to abuse drugs or alcohol -- can also be very effective.

Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.

Edited by Cynthia Haines, MD, WebMD, July 2005.

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Last Editorial Review: 11/28/2005