Hello XXXXXXX,
Welcome to Healthcare Magic and thanks for your query.

I can see that you have been going through a stressful time lately, which in turn is causing you to lose your appetite. Now, appetite is indeed closely liked to mood, and loss of appetite is one of the major symptoms of depression. In fact, both the regulation of mood and the regulation of appetite is mediated by the same neuro-chemical called Serotonin. So, the reason why you don't feel hungry during times of stress / depression may be more that just a lack of interest in food due to your low mood; it may be due to a neuro-chemical imbalance which is causing both your depression as well as your loss of appetite.

Your Body Mass Index (BMI) works out to 23.5, which is within the normal limits, and so, it is unlikely that you have a primary eating disorder. I think that you are actually going through recurrent episodes of depression and your inability to eat is just a "manifestation" of the underlying depression. Still, the drastic loss of weight whenever you go through these depressive episodes, for example, the recent loss of about 10 lbs in one week, is very concerning, and such a drastic weight loss can sometimes result in medical complications also.

In my opinion, it is important to first treat your underlying depression and prevent prevent you from going through further depresive episodes since this itself will sort out your eating problem automatically. Moreover, you do seem to be in the midst of multiple stressful situations - at home, at work, etc. and so, I think you need professional help for managing and coping up with these stressors.

Now, there are effective treatment options available - both in the form of medication as well as psychotherapy, which can help you control and prevent these depressive episodes and thereby tackle your eating problem as well. There are certain specific anti-depressant medication like Mirtazapine, which is not only effective for depression, but also has an appetite stimulating property. So, I would strongly advise you to consult a psychiatrist for starting treatment as early as possible.

In addition, you can try the following tips to help you eat better during your periods of stress / depression:

- Eat small quantities at frequent intervals, rather than trying to have a big meal at once.
- Take high-calorie foods so that even if you eat less, you may still get the required energy. Examples are potatoes, dry fruits, dates, nuts, fresh fruit juices, chocolates, nutrition bars, etc.
- Avoid oily or fatty foods as these can have an effect of quickly causing satiety and decrease appetite.
- Make a list of your favourite foods and keep them stocked at home - this will increase your chances of a better intake.
- Avoid spicy foods, carbonated drinks, caffeine, etc. as these can cause gastric irritation, increase the acid production and cause ulcers, all of which may cause you to feel nauseated and less hungry.
- Start with less quantities initially and gradually keep increasing your intake. This way, you won't develop an aversion when you see large quantities of food.
- Avoid cooking (if possible). Often the continuous smell of food during cooking itself can be a turn-off for your appetite, especially during such times when your appetite is poor.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist

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Hello again XXXXXXX,

I'm glad that you found my suggestions helpful and it's good to hear that you ara quite realistic and positive about your situation. Many a time, we may not be able to do much about the situation we are in, but what is important is to ensure that we keep de-stressing ourselves periodically, so that we don't let too much steam bulid up.

I can understand your view that it may be difficult to discuss about personal and emotional issues to a stranger. Maybe, you can try talking to a close friend regularly, at least so that you feel a little more emotionally supported and less burdened. Please make sure that you also spend some quality time for yourself, say at least 1/2 an hour a day, when you can unwind or do something which you really enjoy. This can be a form of relaxation and a good de-stressor.

When you feel overwhelmed by the stress, tell yourself that this is just a passing phase and that you just have to 'stay afloat', till this bad phase passes away. Practising relaxation techniques like XXXXXXX breathing, listening to relaxing music, etc. can help relieve stress. Ensure that you get 7 - 8 hours of continuous sleep everyday. When you’re sleeping too little or too much, your mood suffers (...and so will your appetite). So, get on a better sleep schedule by practising proper sleep habits. Do at least 20 minutes of regular physical exercise (at least a jog or brisk walk) everyday. This not only keeps your body healthy, but also helps your mind.

All these suggestions, though may appear simple, often help a lot during stressful times. So, keep up your positive attitude and if at any time you feel that it's getting too difficult to handle, please don't hesitate to seek help. If you would like to have a chat with me, your most welcome anytime. You can catch me at:

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Best regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

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Hello again,

I'm sorry to hear about your Mom's deteriorating health and I understand that you must be quite troubled and distressed by the recent turn of events.

Though I may not be in a position to give a definitive opinion on her diagnosis, since I don't know her complete clinical details and findings, I can shed some light on the possibility of a psychological cause.

On a general note, it is possible that psychological stress and inner conflicts can manifest or present as purely bodily symptoms. This is called a "conversion disorder", where a person's severe psychological stress or conflict gets 'converted' into a physical or bodily symptom. The commonest presentation of this disorder is via neurological symptoms - like weakness / paralysis, blindness, sensory loss, fits, etc. (...in the absence of an actual medical or neurological cause). However, I would also like to mention that a diagnosis of a conversion disorder has to be made only after all possible medical causes have been ruled out.

In your Mom's case, there is evidence of swelling of the optic nerve head. However all tests to determine the underlying cause for the swelling have come out negative. So, the key questions here are:
- How significant is the swelling, especially when no causes (neurological, ophthalmological of other systemic) can be traced?
- More importantly, is the clinical swelling "significant enough" or "severe enough" to cause a total loss of vision?

Well, her doctors seem to think that it is not significant enough to produce a total loss of vision and this is probably the reason for asking for a psychiatric consultation.

I think that talking to a therapist would be worthwhile, as it will help in two ways:

1) To have a detailed psychological assessment, to see if there could be any psychological conflicts or emotional stress which could be causing or worsening her visual symptoms.

2) To offer her some form of emotional support and help, especially since she must surely be going through a stressful time with all the multiple medical tests and procedures, as well as dealing with her disability.

I hope I have been able to give you some clarity on this issue.

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

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