Since its introduction to the Western world by the Spanish conquistadors, chocolate has been promoted as being of medicinal value; in 1662, Cardinal Brancaccio declared that it was 'a medicine good for virtually all human ills', and, in the 18th century, Dr Henry Stubbs promoted chocolate balm as a cure for 'hypochondriacal melancholy'.

The search for a therapeutic benefit continues: a recent trial from Germany suggested that eating a small square of dark chocolate a day can produce a clinically significant reduction in blood pressure.¹

Chocolate contains many psychoactive ingredients and interacts with several neurotransmitter systems, including the dopamine, serotonin and endorphin systems. Should we be promoting it to patients with depression?

This study, from Australia, has investigated the prevalence of chocolate craving among patients with depression, and links between chocolate craving and both personality style and atypical depressive symptoms.

The study analysed 2,692 participants aged 18 and over, who reported depressive episodes lasting more than two weeks. Participants were asked about symptoms, coping responses and food cravings, and completed the Temperament and Personality questionnaire.

More than 1,200 participants (45%) stated that they craved chocolate when depressed. Women were significantly more likely to crave chocolate than men.

Participants who craved chocolate judged it to be beneficial for depression, anxiety and irritability.

There was a significant association between chocolate craving and neuroticism (the tendency to be anxious, worried and socially insecure). However, only two of the five personality facets of neuroticism significantly predicted craving: irritability and rejection sensitivity.

The DSM-IV defines atypical depression as a subtype of major depression characterised by mood reactivity (lifting of mood in response to positive events) together with at least two of the following: increased appetite/weight gain, hypersomnia, leaden paralysis and longstanding interpersonal rejection sensitivity.²

'Atypical' is a misnomer; around one quarter of patients who are depressed fulfil these criteria.³ It has been suggested that the primary feature is hypersensitivity to rejection, which can be associated with panic disorder and social phobia.⁴ CBT theory links rejection sensitivity to a patient's core belief of being unlovable.⁵

This study found that there was a significant association between chocolate craving and the symptoms of atypical depression (other comfort behaviours, such as hot baths, were also significantly linked). The authors suggest that a simple question about chocolate craving may be a useful screening tool for this condition.

A prescription of chocolate, hot baths and plenty of sleep is not a panacea for depression. There may, however, be a subgroup of patients whose personality not only makes them vulnerable to depression, but also allows them to alleviate symptoms in this way.