Antidepressants Lift Mood but Quietly Reshape Eating Attitudes in Vietnamese Patients

Antidepressant medications are designed to lift patients out of the darkness of major depressive disorder, and by most conventional measures they succeed. But a new prospective cohort study from Vietnam suggests that as mood improves, something unexpected may be happening on the plate. Researchers tracking 250 adults with major depressive disorder over six months of antidepressant treatment found that while depressive symptoms fell dramatically, scores measuring disordered eating attitudes and behaviors climbed steadily and substantially, a divergence that could reshape how clinicians monitor recovery.

The study, conducted at the University Medical Center Ho Chi Minh City and published in Discover Mental Health, followed patients who were either initiating or continuing antidepressant therapy. Participants were assessed at four time points: baseline, one month, three months, and six months. Depressive symptoms were measured with the Quick Inventory of Depressive Symptomatology–Self-Report, a sixteen-item instrument widely used in clinical research, while eating attitudes and behaviors were tracked using the Eating Attitudes Test-26, a validated screening tool that captures dieting behavior, food preoccupation, and oral control.

At the start of the study, the clinical picture was severe. More than 32 percent of participants scored above 15 on the QIDS-SR16, indicating severe or very severe depression. This is consistent with the reality that many patients reach psychiatric care only after symptoms have become disabling. Major depressive disorder has long been linked to disturbances in appetite and weight, with some patients losing interest in food entirely and others turning to eating as a coping mechanism. What has remained underexplored, the authors note, is how these psychological attitudes toward eating evolve once treatment begins and mood begins to stabilize.

The trajectory of depression over the six months was, by every standard metric, a success story. By the end of follow-up, 45.2 percent of participants had achieved remission, meaning their depressive symptoms had receded to clinically insignificant levels. For a condition that resists treatment in a large fraction of patients, this remission rate represents meaningful therapeutic progress and underscores the effectiveness of pharmacological care delivered in a structured outpatient setting.

The eating data told a strikingly different story. The mean EAT-26 total score rose from 4.7 at baseline to 17.0 at six months, a mean increase of 12.3 points that was highly statistically significant. All three subscales of the instrument—Dieting, Bulimia and Food Preoccupation, and Oral Control—showed significant progressive increases over the same period. Perhaps most alarming from a screening standpoint, the proportion of patients crossing the conventional clinical threshold of an EAT-26 score of 20 or higher grew from just 1.6 percent at baseline to 39.6 percent at six months. In other words, roughly two in five patients who began treatment with unremarkable eating attitudes ended the study period scoring in a range typically associated with elevated risk of disordered eating.

To understand what was driving this shift, the researchers turned to generalized structural equation modeling, a statistical framework capable of handling multivariate longitudinal associations while accounting for the complexity of repeated measurements. Two factors emerged with particular force. Patients who reported increased appetite or weight gain during treatment scored substantially higher on the EAT-26, with a beta coefficient of 3.2, while those who achieved clinical remission of their depression scored significantly lower, with a beta of minus 6.1. Both associations were highly significant, and together they sketch a nuanced picture: recovery itself appears protective, but the metabolic and appetite side effects that often accompany antidepressant medications may push patients toward dieting behaviors, food preoccupation, and restrictive attitudes even as their mood improves.

This finding carries particular weight given the pharmacology of modern antidepressants. Selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, and noradrenergic and specific serotonergic antidepressants all interact with neural circuits that regulate both mood and appetite. Some agents are well known to stimulate appetite and promote weight gain, effects that patients frequently report as distressing. The new study suggests these physical changes are not merely cosmetic concerns but may translate into measurable psychological distress centered on food, body, and control, even in patients whose depression is otherwise responding well to treatment.

The authors argue that the divergence between mood improvement and worsening eating attitudes exposes a blind spot in routine psychiatric monitoring. Clinical follow-up for depression typically focuses on mood, sleep, energy, and suicidal ideation, while eating attitudes are rarely assessed unless a patient volunteers concerns. Because the conventional EAT-26 cutoff of 20 would have flagged only the extreme end of the distribution, the researchers emphasize that continuous measures, rather than binary clinical thresholds, are essential for detecting the gradual erosion of healthy eating attitudes that their data reveal. A patient scoring 17 would escape screening under current practice, yet sits within a population whose mean scores more than tripled over six months.

The study’s setting adds an important dimension to its significance. Research on eating psychopathology in depression has been concentrated in high-income Western countries, and data from Southeast Asian populations remain scarce. Cultural factors shape both the expression of depression and attitudes toward food, body size, and dieting, and treatment guidelines imported from other contexts may not transfer cleanly. By demonstrating that the mood-eating divergence emerges in a Vietnamese outpatient cohort, the study suggests the phenomenon is not an artifact of Western clinical populations but a potentially general feature of antidepressant treatment that deserves attention across diverse health systems.

For clinicians, the practical message is straightforward: recovery from depression should be monitored with a wider lens. Patients whose mood is improving but who report new appetite changes, weight gain, or growing preoccupation with food and dieting may be developing disordered eating attitudes that warrant intervention before they harden into clinical eating disorders. For researchers, the findings open a clear agenda for future work, including studies that disentangle the effects of specific antidepressant classes, examine whether the trajectory reverses with longer follow-up, and test whether structured nutritional and psychological support during treatment can prevent the rise in disordered eating attitudes. What this study makes unmistakably clear is that healing the mind and healing the relationship with food are not always the same journey, and that treating depression successfully means watching both.

Subject of Research: Longitudinal changes in disordered eating attitudes and behaviors during antidepressant treatment for major depressive disorder

Article Title: Changes in depressive symptoms and disordered eating attitudes and behaviors during antidepressant treatment among Vietnamese patients with major depressive disorder

Article References: Bui, M. X., Ngo, L. T., Huynh, N., Le, P. T. V., Vuu, L. T. M., Nguyen, N. T. Y., & Nguyen, P. D. (2026). Changes in depressive symptoms and disordered eating attitudes and behaviors during antidepressant treatment among Vietnamese patients with major depressive disorder. Discover Mental Health. https://doi.org/10.1007/s44192-026-00598-y

Image Credits: AI Generated

DOI: 10.1007/s44192-026-00598-y

Keywords: major depressive disorder, antidepressants, disordered eating, EAT-26, QIDS-SR16, appetite changes, weight gain, Vietnam, longitudinal study, psychiatry, mental health, remission