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

Major Depressive Disorder (MDD) is linked to appetite and weight disturbances. While antidepressants (ADs) stabilize mood, their impact on psychological eating attitudes and behaviors remains underexplored. This study aimed to investigate longitudinal changes in mean EAT-26 total and subscale scores (measuring disordered eating attitudes and behaviors) and to identify predictors over six months in Vietnamese MDD patients. This single-center prospective cohort study at the University Medical Center Ho Chi Minh City enrolled 250 adult outpatients diagnosed with MDD who were initiating or continuing AD therapy. Participants were followed at baseline (T0), one month (T1), three months (T3), and six months (T6). Depressive symptoms were measured using the Quick Inventory of Depressive Symptomatology–Self-Report (QIDS-SR16), and eating attitudes and behaviors using the Eating Attitudes Test-26 (EAT-26). Multivariate associations were analyzed using generalized structural equation modeling (GSEM). At baseline, 32.3% of participants had severe or very severe depression (QIDS-SR16 > 15). Depressive symptoms improved significantly (45.2% remission at six months). However, the mean EAT‑26 total score increased substantially from 4.7 ± 5.1 at baseline to 17.0 ± 18.3 at six months (mean difference + 12.3, p < 0.001). All subscales—Dieting, Bulimia/Food Preoccupation, and Oral Control–showed significant progressive increases ( p < 0.001). The prevalence of patients with EAT‑26 ≥ 20 increased from 1.6% at baseline to 39.6% at six months. “Increased Appetite/Weight Gain” was a strong predictors of higher EAT-26 scores (β = 3.2, p < 0.001), while clinical remission was associated with lower scores (β = − 6.1, p < 0.001). The study identifies a divergence between mood improvement and the progressive worsening of mean EAT-26 scores during antidepressant treatment. Routine screening for disordered eating attitudes and behaviors – using continuous measures, not merely clinical cutoffs – is essential throughout depression treatment.