Take back control of anorexia

The young woman is a member of the athletics team at the University of Windsor, where she is also studying kinesiology. His discipline: the high jump. However, his eating disorder led him to severely restrict his diet, while training excessively, up to four hours a day, seven days a week. A rhythm that his body could no longer stand.

” I have colds all the time. I always hurt myself. I had a stress fracture in my femur from running too much. It started affecting my white blood cells, my kidneys and my liver. »

In recent years, the young athlete has been hospitalized several times. He also underwent psychotherapy, and was prescribed medication to treat his symptoms of anxiety and depression. However, this did not solve the root of the problem.

When I was given therapy tools to try to reduce my anxiety, it didn’t work, she says. The only thing that helps reduce it is to do my usual behavior. Medications for anxiety and depression helped improve my mood, but they didn’t change my behavior. I stay motivated to keep doing what I’m doing, just by being in a better mood.

This illustrates the limitations of standard treatment for eating disorders. We don’t have medications that directly treat the symptoms of eating disorders, such as depression.says Toronto psychiatrist Leora Pinhas, who has been following Madelyn Eybergen for two years.

” Anorexia has one of the highest mental health mortality rates, after substance abuse disorders. Of those who are not cured, one in ten will die. »

Psychiatrist Leora Pinhas specializes in the treatment of eating disorders.

Photo: Radio-Canada

An autopilot in the brain

Madelyn Eybergen is well aware of the impact her eating disorder has had on her life. He wanted to get out of it, but didn’t have the courage. My thoughts and emotions are always in conflict, he explained. For the past few years, I’ve wanted to get better, I’ve wanted to be healthy. But my eating disorder works in the opposite direction.

Behind eating disorders are very stubborn habits, as explained by Dr. Pinch. There is a part of our brain that has a kind of autopilot, and in some people the autopilot can get stuck. So when they try to change something, they are overwhelmed with anxiety. You can talk to a patient. He understands why he needs to gain weight and eat. He is very reasonable. But two hours later, he may be in front of the food and beset with anxiety about changing his routine.

Neuroscience researcher Salah El Mestikawy, from the Douglas Mental Health University Institute in Montreal, became interested in this autopilot by studying the brains of genetically modified mice. These rats have a predisposition to develop compulsive behavior. They lack flexibility, they are quite psycho-rigid, he said. Once they learn to do one thing, if we change the instructions, it will be difficult for them to do something else.

Neuroscientist Salah El Mestikawy became interested in the cause of eating disorders.

Photo: Radio-Canada

” There are similarities betweenaddictionanorexia, bulimia and obsessive-compulsive disorder, where there is this dimension of doing and taking an action despite the negative consequences. »

The rats he was studying were conditioned to develop a form of anorexia. By gradually depriving them of food during the day, the researcher led them to prefer running around their cage to eating. When food is offered to them again, some continue to run compulsively and barely eat. When they lose more than 25% of their base weight, they are considered anorexic.

The researcher studied rats that were conditioned to be anorexic.

Photo: Radio-Canada

When the brake stops working

Salah El Mestikawy focuses on the parts of the brain responsible for our behavior. He studied the striatum, which includes the nucleus accumbens—part of the reward center—the caudate nucleus—which directs goal-directed behaviors—and the putamen, which is responsible for habit formation.

The striatum mainly consists of the caudate nucleus, the nucleus accumbens and the putamen.

Photo: Radio-Canada / Maxime Lech

The nucleus accumbens and the caudate nucleus are involved in learning new actions, such as driving a car. The putamen, on the other hand, makes it possible to transform this learning into a habit. You should know that this is a mode that makes us very good, a very important modeexplained the researcher.

: \”Il y a un billet de 100$, va le chercher\”; ou quelque chose qui va vous dire: \”Non, là, il y a un poison venimeux, un serpent venimeux, n’y va pas\”; ou: \”Si tu manges ça, tu vas mourir\”. Quelque chose qui va vous faire faire l’action ou vous bloquer l’action”,”text”:”Chaque sous-région a un frein et un accélérateur, quelque chose qui va vous dire: \”Il y a un billet de 100$, va le chercher\”; ou quelque chose qui va vous dire: \”Non, là, il y a un poison venimeux, un serpent venimeux, n’y va pas\”; ou: \”Si tu manges ça, tu vas mourir\”. Quelque chose qui va vous faire faire l’action ou vous bloquer l’action”}}”>Each sub-region has a brake and an accelerator, something that tells you: “There’s a $100 bill, take it”; or something that will tell you: “No, there is a poisonous poison there, a poisonous snake, don’t go there”; or: “If you eat it, you will die”. Something that will push you to take action or block you from action, he explains. Dopamine is the neurotransmitter that controls this mechanism. Dopamine, when it comes to these structures, it will press the accelerator and it will block the brake, the brake will no longer work.

Thus, when the level of dopamine in the putamen is higher than in the nucleus accumbens and the caudate nucleus, automatic behaviors take over. This is how disorders such as anorexia manifest, becoming difficult to control.

To restore balance, Salah El Mestikawy identified another neurotransmitter, acetylcholine, which has the effect of increasing dopamine levels in the nucleus accumbens and the caudate nucleus, but does not affect the putamen. This will allow a continuation of control, as the other two regions will be stronger than before.he explains.

An unexpected drug

Increasing acetylcholine in the brain, however, is not an easy task. To achieve this, the Douglas Institute researcher used a drug used to treat some cognitive problems in Alzheimer’s disease, donepezil.

In the brain, an enzyme is called acetylcholinesterase destroys acetylcholine. ElMestikawy. Et ce que fait le donépézil, c’est qu’il vient se loger dans le site actif de cette enzyme, et il va la bloquer. En faisant ça, il va empêcher la dégradation de l’acétylcholine, et donc il va prolonger l’action. Il va augmenter les taux de l’acétylcholine à l’extérieur des neurones.”,”text”:”C’est comme un Pac-Man qui découpe l’acétylcholine en deux morceaux et qu’il inactive en faisant ça, explique le PrElMestikawy. Et ce que fait le donépézil, c’est qu’il vient se loger dans le site actif de cette enzyme, et il va la bloquer. En faisant ça, il va empêcher la dégradation de l’acétylcholine, et donc il va prolonger l’action. Il va augmenter les taux de l’acétylcholine à l’extérieur des neurones.”}}”>It is like a Pac-Man that cuts acetylcholine into two pieces and inactivates it by doing so, explains Professor El Mestikawy. And what donepezil does is it goes into the active site of that enzyme, and it blocks it. By doing so, it prevents the breakdown of acetylcholine, and therefore prolongs its action. This will increase the levels of acetylcholine outside the neurons.

By increasing the level of acetylcholine, it increases dopamine in the nucleus accumbens and the caudate nucleus, and reduces the influence of automatic behaviors.

Salah El Mestikawy and his colleague Erika Vigneault study neurotransmitters in the mouse brain.

Photo: Radio-Canada

Results in a few weeks

The neuroscientist obtained good results by giving donepezil to his anorexic laboratory rats: their weight returned to normal. But what about people? To find out, he turned to Dr. Leora Pinhas, who agreed to try it on some of her patients. As a precaution, the psychiatrist prescribes it in doses lower than those usually used for the treatment of Alzheimer’s.

” I told Leora that I thought donepezil would work pretty quickly on the flexibility and compulsiveness side. And that’s exactly what he described to me. This is surprising because, even with very low doses, the anticompulsive effects are very rapid. »

I think I notice a difference in a month, sometimes less. Very goodconfirmed by Dr. Pinhas, who has tried it so far on half a dozen of his patients.

Madelyn Eybergen is one of them. ou 10minutes par jour, et nous n’y arrivions pas. Quelques semaines après avoir commencé le médicament, elle a réussi à augmenter la variété de ce qu’elle mangeait et elle a pu réduire son temps d’entraînement de moitié.”,”text”:”C’était une patiente qui avait tout essayé et qui était vraiment coincée dans un état qui affectait sa vie, note la psychiatre. Durant deux ans, nous tentions de l’amener à réduire son temps d’entraînement de 5ou 10minutes par jour, et nous n’y arrivions pas. Quelques semaines après avoir commencé le médicament, elle a réussi à augmenter la variété de ce qu’elle mangeait et elle a pu réduire son temps d’entraînement de moitié.”}}”>He was a patient who had tried everything and was really stuck with a condition that was affecting his life, the psychiatrist said. For two years, we tried to get him to reduce his training time by 5 or 10 minutes a day, and we couldn’t. A few weeks after starting the medication, she was able to increase the variety of what she ate and was able to cut her exercise time in half.

The young woman confirmed that donepezil helped her regain control of her behavior, where previous treatments had failed. I used to have a goal of taking care of my health, but I never felt able to make these changes.he says.

” Along with medication, it helps me overcome the anxiety I feel when trying to make these changes. »

Madelyn Eybergen was able to resume high jumping after undergoing treatment.

Photo: Madelyn Eybergen

However, donepezil has its drawbacks: it significantly increases blood pressure, which can be dangerous for patients whose physical health is already fragile. To treat anorexic patients, the doctor and the researcher agreed to prescribe it at a tenth of the usual dose, which required special preparation.

To avoid this problem, Salah El Mestikawy is currently working on developing a new molecule that will have the same effect as donepezil on the brain, but without its side effects. Until this drug is ready, donepezil remains a temporary solution, which the researcher now wants to test in larger groups of patients.

As for Madelyn Eybergen, the treatment allowed her to return to a normal life. I was able to recover from my wounds last year, he said. I have no pain anywhere. I have more energy, and I’m not cold all the time. Above all, he was able to continue practicing his favorite sport. I’m better, I run faster, I’m stronger, and I hope to compete this year.he said hopefully.