Patients with
bulimia nervosa (BN) have bulimic and depressive symptoms, which have been associated with abnormalities in the neuroendocrine and vagal systems. Subjects included twenty-four female drug-free outpatients with BN that were selected from patients seeking treatment for eating behavior in our hospital along with twenty-five age-matched healthy females who served as controls. We investigated
ghrelin and
leptin levels, cardiac vagal tone and sympathovagal balance, frequency of sets of
binge-eating and
vomiting episodes per week and the Profile of Mood States (POMS) depression scale in BN before and after a 16-week administration of the
serotonin selective reuptake inhibitor (SSRI)
paroxetine combined with cognitive-behavioral therapy. Compared to controls, the BN group had higher
ghrelin levels and resting cardiac vagal tone, and lower
leptin levels and resting cardiac sympathovagal balance before treatment, although there was a significant difference between the two groups for the body mass index (BMI). The elevated
ghrelin levels (301.7 +/- 18.9 pmol/l, mean +/- SEM vs. 202.8 +/- 15.6 pmol/l, P < 0.01), cardiac vagal tone (2246.4 +/- 335.5 ms(2) vs. 1128.5 +/- 193.3 ms(2), P < 0.01), frequency of sets of
binge-eating and purging episodes and T scores for the POMS depression scale were all significantly decreased
after treatment despite similar BMI, percent body fat and
leptin levels. In close association with cardiac vagal function and
ghrelin recoveries, abnormal eating behavior and depressive symptoms improved, indicating the usefulness of these indexes in the assessment of clinical condition and therapeutic efficacy in BN.