Dispassionate kisses

Self medicating for mood disorders is well known. It is often quite harmful, with the chief culprits being ethyl alcohol and nicotine. But there are others. One that comes up often is chocolate as an antidote to feelings of depression. Not everyone who eats chocolate is depressed, of course. Probably most of us who do it do it because we like chocolate. When I was in elementary school I used to eat a lot of Hershey bars after school. They cam in six-packs and one memorable day I found two whole packs and one pack with a single bar missing. I ate all 17 in one sitting. Two hours later I ate dinner. I couldn't do that again, both because I would gain weight with the speed of light (I still have a BMI under 25 but I'm pushing it) and because I wouldn't have any appetite for dinner. Nor would it make me feel better. Probably just sick to my stomach.

But a lot of people do report that they crave chocolate when they are feeling down, so a recent article in Archives of Internal Medicine tested the proposition that this was a case of self medicating:

People battling signs of major depression showed a yearning for chocolate that drove them to eat twice as much of the sweet treat as those not depressed, University of California researchers said.

Adults with symptoms of severe depression gobbled an average of 11.8 one-ounce servings a month, according to the study. That’s comparable to about six dozen Hershey’s Kisses monthly. Individuals not depressed ate 5.4 one-ounce servings, and those who showed possible signs of the condition nibbled 8.4, the scientists said. Men consumed almost as much chocolate as women, according to data on more than 900 adults. (Nicole Ostrow, Bloomberg)

By the standards of someone who ate 17 Hersey bars in one sitting, 6 dozen chocolate kisses doesn't sound like a lot, but it is clear that people who answered a general questionnaire about diet (including chocolate consumption) and a set of questions to evaluate depressive affect ate considerably more chocolate than others. Using a common scale, the Center for Epidemiological Studies-Depression Scale (CES-D) that has been widely used and validated. The Results, from the Abstract of the paper:

Those screening positive for possible depression (CES-D score 16) had higher chocolate consumption (8.4 servings per month) than those not screening positive (5.4 servings per month) (P = .004); those with still higher CES-D scores (22) had still higher chocolate consumption (11.8 servings per month) (P value for trend, <.01 these="" associations="" extended="" to="" both="" men="" and="" women.="" findings="" did="" not="" appear="" be="" explained="" by="" a="" general="" increase="" in="" fat="" carbohydrate="" or="" energy="" intake.="" depressive="" symptoms="" cross-sectional="" analysis="" natalie="" rose="" md="" sabrina="" koperski="" bs="" beatrice="" a.="" golomb="" phd="" href="http://archinte.ama-assn.org/cgi/content/full/170/8/699?etoc">Arch Intern Med. 2010;170(8):699-703.

Here's a bar graph that shows the data, which are fairly impressive looking in this form:

What this study showed is that the difference in chocolate consumption was not explained by a number of other possible mood-related dietary items like sugar, caffeine and fat. On the other hand, it is possible that the higher CES-D respondents were different in other ways that were reflected in chocolate consumption.

On the basis of this study, if chocolate consumption is truly a form of self medication, like other examples it doesn't do the trick. That's not unusual. Just because your body is telling you to do something, doesn't mean that it knows what it's talking about.

Meanwhile I will go on eating chocolate without worrying that it's a sign of depression. Sometimes a kiss is just a kiss.

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Here's a bar graph that shows the data, which are fairly impressive looking in this form:

The graph is missing. No link, no jpeg.

Here's a link in honor of the post's title, though:

http://www.youtube.com/watch?v=IMGMT3_Dx4k

The data are from the paper which is linked above in the text and the abstract.

What counts as self medicating? I drink a lot of Pepsi Max when my mood is low, as the caffeine boosts it. That would be self-medicating. But what if I drank lots of caffeine-free cola when down?
If chocolate consumption is self medication, is cheese consumption?

Enders: if you consume Pepsi to feel better that is considered self medicating. It depends on why you do it and for what.

Thank goodness, I prefer walks in the woods when I'm feeling extremely down.

The first link came up with this message:
"The requested URL /effectmeasure/2010/04/the Center for Epidemiological Studies-Depression Scale (CES-D) was not found on this server."

So, what does this say about those of us that never crave (and rarely eat) chocolate (or any sort of candy for that matter)?

Am I chemically imbalanced in another way?

With the caveat that I haven't read the paper, did they normalize chocolate consumption against other foods (i.e. potato chips, ice cream, cheezy poofs, etc.). In other words, would chocolate not be the only thing consumed but be the only thing measured in the study?

By MS, MT(ASCP) (not verified) on 28 Apr 2010 #permalink

MS: yes, they took a dietary history.and added other food categories into the model, as indicated in the post.

The only two times I've ever developed a "chocolate craving" were when I've drastically cut down fats to lower cholesterol. Of course this is one case and situation only, and I'm not sure how/if it relates in any case to how the study's "findings did not appear to be explained by a general increase in fat, carbohydrate, or energy intake," but seems not irrelevant.

The self medication hypothesis usually refers to addictive substances used to treat mood problems, popularized by psychoanalayst Edward Khantzian among others.

Revere, while the sheer quantity of your chocolate use in earlier years could earn one a "chocolate abuse vs chocolate dependence" label, you were not self medicating.

Meanwhile, even moderate use of chocolate could be seen as self medicating if it is simply used to alleviate dysphoric mood states. Is an addictive use pattern a prerequisite to the diagnosis of "self medication" in this study? I think not since chocolate dependence is not in DSM IV TR. We need a better definition of chocolate dependence.

Also, those with depression are much more sensitive to withdrawal effects on mood and so it is possible they are medicating chocolate withdrawal dysphoria more than baseline depression. :)

By Dr Denise (not verified) on 28 Apr 2010 #permalink

Dr. Denise: I agree. I was definitely not self medicating. OTOH, I know many people who use the term self-medication for things that are not addictive but still used to treat some dysphoric mood or other problem (e.g., pain). So not all chocolate eating, even binge eating, is self medication and not all self medication is for mood disorder or with addictive substances.