the Absence of Hunger: A Mental Health Perspective

Lack of appetite?

Hello, doctor.
Since the end of December last year, I have been struggling in my master's program and often find myself questioning the direction and purpose of my life.
By early January this year, I felt something was off and decided to see a psychiatrist.
I consulted two different doctors from January to February and was prescribed several medications (including Paroxetine, Clonazepam, Lamotrigine, Sertraline, Mirtazapine, and Venlafaxine).
After about two weeks on these medications, I felt they were ineffective and stopped taking them.
Since mid-January, I have not experienced any feelings of hunger (though I still eat, particularly craving sweet foods).
My sleep has been shallow (more like resting with my eyes closed), and this has continued until now.
I have become accustomed to the shallow sleep, but the lack of hunger still confuses me.
I went to a gastroenterologist for an endoscopy and discovered that I have symptoms of gastroesophageal reflux disease (GERD) and a duodenal ulcer.
However, the doctor informed me that these conditions are not directly related to my lack of appetite and advised me to return to a psychiatrist.
The doctor suggested I seek psychological counseling, but I found that it was not effective for me (it seemed that the doctors lost patience with me over time).
Additionally, I am reluctant to take antidepressants again unless there is concrete evidence from diagnostic tools indicating what is wrong and a targeted treatment plan.
I would like to ask what I should do now...

Jie, 20~29 year old female. Ask Date: 2016/05/03

Dr. Zhong Mingxun reply Psychiatry

There is no feeling of hunger (but still eating, with a particular craving for sweet foods), and sleep is shallow (like just resting with eyes closed).
This has been ongoing until now.
Essentially, these two issues reflect your psychological stress, especially since you are currently facing significant life uncertainties.
This type of pressure is a substantial internal stress.
Antidepressants may require continuous use for more than a month to potentially be effective.
It is advisable to consider psychological counseling as a more fundamental solution.
However, trust in your doctor or therapist is crucial, and finding a high-quality therapist who is suitable for you may not be easy.
It would be best to gather some information first.

Reply Date: 2016/05/03

More Info

It sounds like you are experiencing a complex interplay of mental health issues and physical symptoms, particularly the absence of hunger and shallow sleep. These experiences can be quite distressing and may lead to further anxiety and confusion about your overall well-being. Let's break down your situation and explore some potential avenues for understanding and addressing your concerns.

Firstly, the absence of hunger can be a significant indicator of underlying mental health issues, particularly depression or anxiety. When individuals are experiencing emotional distress, it is common for their appetite to be affected. This can manifest as a lack of hunger or a preference for certain types of food, such as sweets, which may provide a temporary sense of comfort or pleasure. The brain's chemistry is intricately linked to our physical sensations, including hunger. Neurotransmitters like serotonin and dopamine, which are often targeted in antidepressant medications, play a crucial role in regulating mood and appetite. If these neurotransmitters are imbalanced, it can lead to changes in how you perceive hunger and satisfaction.

Your experience of shallow sleep is another critical factor to consider. Sleep disturbances are often associated with mental health conditions, including anxiety and depression. When the mind is preoccupied with worries or existential questions, it can be challenging to achieve restorative sleep. This lack of quality sleep can exacerbate feelings of fatigue, irritability, and cognitive difficulties, creating a vicious cycle that further impacts your mental health.

Given that you have already sought help from multiple psychiatrists and have tried various medications without significant improvement, it may be beneficial to explore alternative therapeutic approaches. Here are some suggestions:
1. Cognitive Behavioral Therapy (CBT): This form of therapy focuses on identifying and changing negative thought patterns and behaviors. It can be particularly effective for anxiety and depression, helping you develop coping strategies and improve your overall mental health.

2. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, yoga, or deep breathing exercises can help reduce anxiety and improve your overall sense of well-being. These techniques can also promote better sleep quality and may help you reconnect with your body's hunger signals.

3. Nutritional Counseling: Since you mentioned a particular craving for sweets, working with a nutritionist could help you develop a balanced eating plan that addresses your cravings while ensuring you receive adequate nutrition. They can also provide guidance on how to manage symptoms related to gastroesophageal reflux disease (GERD) and peptic ulcers.

4. Regular Physical Activity: Engaging in regular exercise can have profound effects on both physical and mental health. Exercise releases endorphins, which can improve mood and reduce feelings of anxiety. It can also help regulate appetite and improve sleep quality.

5. Support Groups or Peer Counseling: Sometimes, sharing your experiences with others who are going through similar challenges can provide comfort and insight. Support groups can offer a sense of community and understanding that may be beneficial in your healing journey.

6. Re-evaluating Medication: If you are open to it, consider discussing with a psychiatrist the possibility of trying different classes of medications or adjusting dosages. Sometimes, it takes time to find the right medication that works for you.

7. Holistic Approaches: Exploring holistic therapies such as acupuncture, aromatherapy, or herbal supplements may provide additional support. However, it's essential to consult with a healthcare professional before starting any new treatment.

In conclusion, your experiences of not feeling hungry and having shallow sleep are valid and deserve attention. It is essential to continue seeking support and exploring different therapeutic avenues until you find what works best for you. Mental health is a journey, and it often requires patience and persistence. Remember, you are not alone in this, and there are resources and people available to help you navigate through these challenges.

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