PsychopharmacologyDOI 10.1007/s00213-007-1046-y
Serotonin transporter binding in eating disorders
Per Södersten & Cecilia Bergh
Received: 28 September 2007 / Accepted: 4 December 2007
A recent report suggested that patients who are in remission
a full remission, i.e., display no symptoms at discharge, run
from an eating disorder have “divergent 5-HTT (serotonin
a less than 10% risk of relapse during a 5-year period of
transporter, our addition) activity” in some brain areas and
raised the possibility that “this is a premorbid vulnerability
The recent report by Bailer et al. provides an
for developing ED (eating disorder, our addition) symp-
example of the first interpretation. Thus, as the patients in that
toms” (Bailer et al. ). However, the patients also had
report showed increases in perfectionism and anxiety, some
increased levels of perfectionism and anxiety, and the
patients had even elevated levels of obsessive compulsive
alteration in 5-HTT activity may, therefore, be related to
disorder, it cannot be excluded that the “divergent 5-HTT
these symptoms rather than the previous eating disorder.
activity” that Bailer et al. reported is an epiphenomenon
With one exception (Bergh et al. ), there are no
to these symptoms and unrelated to the eating disorder. This is
effective treatments for patients with eating disorders, such
a problem with all studies on biological changes among eating
as anorexia and bulimia nervosa (Berkman et al. As
disorder patients (Södersten et al. ). Most of these
a consequence, patients who are discharged from treatment
changes, as well as their psychological concomitants are
are never free of symptoms. While they may be in
reversible consequences of starvation, and unless the patient is
remission from their eating disorder, they typically display
properly treated, some of the symptoms persist, and the patient
symptoms such as perfectionism and anxiety (Bailer et al.
merely goes into partial remission and remains at risk of
), and most often, they relapse within a year or less
We do not know, therefore, whether the “divergent 5-HTT
There are two ways to interpret this situation. Firstly,
activity” in the brain reported by Bailer et al. is a cause
there may be something wrong with a patient, e.g.,
or a consequence of an eating disorder.
“divergent 5-HTT activity” in the brain, which puts her/
There is another issue that needs clarification in the
him at risk of developing an eating disorder and persists at
report of Bailer et al. ). Thus, the standard deviations
remission. This is the common interpretation (e.g., Bailer
in their Table 1 are greater than the associated mean values
et al. Secondly, it is possible that there is something
in 13 instances. For example, recovered anorexic women,
wrong with the treatments offered to patients with eating
restricting type (REC RAN) are reported to have a blood
disorders (Södersten et al. ). Patients who are treated to
level of estradiol of 19.56 (26.68) pg/ml. This implies thatin some women, blood levels of estradiol were negative,which is impossible.
P. Södersten (*) C. BerghKarolinska Institutet, Section of Applied Neuroendocrinology,Mandometer Clinic,Novum,
(27.5%) are owners of the Mandometer Clinics together with Investor
Bergh C, Brodin U, Lindberg G, Södersten P (2002) Randomized
controlled trial of a treatment for anorexia and bulimia nervosa. Proc Natl Acad Sci U S A 99:9486–9491
Bailer UF, Frank GK, Henry SE, Price JC, Meltzer CC, Becker C,
Berkman ND, Lohr KN, Bulik CM (2007) Outcomes of eating
Ziolko SK, Mathis CA, Wagner A, Barbarich-Marsteller NC,
disorders: a systematic review of the literature. Int J Eat Disord
Putnam K, Kaye WH (2007) Serotonin transporter binding after
recovery from eating disorders. Psychopharmacology (Berl)
Södersten P, Bergh C, Zandian M (2006) Psychoneuroendocrinology
of anorexia nervosa. Psychoneuroendocrinology 31:1149–1153