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Indian J Psychiatry
Indian J Psychiatry
IJPsy
Indian J Psychiatry
Indian Journal of Psychiatry
0019-5545
1998-3794
Wolters Kluwer - Medknow India

IJPsy-66-665
10.4103/indianjpsychiatry.indianjpsychiatry_914_23
Case Series
Unusual presentation of desiderosmia in major depressive disorder: A case series of four patients from Eastern India
Layek Avik Kumar
Makhal Manabendra 1
Majumder Uttam
Sarkar Sharmila 1
Department of Psychiatry, North Bengal Medical College, West Bengal, India
1 Department of Psychiatry, Calcutta National Medical College, Kolkata, West Bengal, India
Address for correspondence: Dr. Sharmila Sarkar, Department of Psychiatry, Calcutta National Medical College, 32, Gorachand Road, Kolkata - 700 014, West Bengal, India. E-mail: drsharmilasarkar@gmail.com
7 2024
17 7 2024
66 7 665667
02 12 2023
23 5 2024
04 7 2024
Copyright: © 2024 Indian Journal of Psychiatry
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Abnormal and excessive desire to smell certain odors or objects (desiderosmia) is reported to be seen with iron deficiency anemia. We present here four cases of desiderosmia in diagnosed patients of major depressive disorder without iron deficiency, where treatment of depression was associated with improvement in abnormal craving.

Chalk
depression
desiderosmia
olfactory craving
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pmcINTRODUCTION

Desiderosmia, a term coined by Hansen et al.,[1] is an excessive desire to smell certain odors, usually associated with iron deficiency anemia. Sometimes behaviors, such as pica (consumption of inedible substances), can be associated with desiderosmia.[2] It has been mentioned that the traces of substances in the oronasal cavity motivate the person to pursue such a habit. However, whether behavior, such as pica or desiderosmia, is always associated with iron deficiency is debatable as the consumed or smelled substances rarely contain bioavailable iron.[3] Other proposed causes of such behaviors should also be considered, including certain psychiatric conditions.[4] We present here four cases of desiderosmia who had no history of pica or iron deficiency. In these cases, the smell was not accompanied by volatile solvent use, and all of them had diagnosed with major depressive disorder for which they attended the psychiatry outpatient department (OPD) between 2019 and 2023.

Curiously, addressing the underlying psychiatric condition resulted in the improvement of patients with desiderosmia across all four cases, highlighting a potential avenue for future research into its causes and treatment methods.

CASE SERIES

Case 1

A 48-year-old married Hindu woman, hailing from a rural joint family of middle socioeconomic status, presented with recurrent depressive disorder for the last 8 years. The latest episode of severe depression without psychotic symptoms started 4 months back. It was associated with tension-type headache and prominent anxiety. No obsessive-compulsive feature or substance use was reported. There was a history of bipolar disorder in one of her second-degree relatives. She complained of a strong desire to store calcareous earth in the room, to sprinkle water over it, and to smell it almost daily, especially while in distress. She was fond of Petrichor as well. She found this behavior soothing her stress serendipitously after the onset of the latest depressive episode. There was no history of pica. She refrained from indulging in this habit when visiting relatives or during festivals without significant difficulty. Only her daughter was privy to this habit, and she cooperated in keeping it concealed from others.

Investigation revealed iron profile, zinc, and calcium levels were within normal limits as shown in Table 1. She was prescribed sertraline showing significant improvement of depression as well as desiderosmia at the dose of 200 mg per day.

Table 1: Clinical summary of the cases

Cases	Diagnosis	Olfactory craving	Hb (g/dl)	Hct (%)	MCV (fL)	Ferritin (mcg/L)	TIBC	Ca (mg/dl)	Zn (μmol/L)	Treatment	
1) 48 yrs Female	RDD	Chalk	11.7	38.4	83.4	21.2	376	9.2	13.1	Sertraline 200 mg	
2) 34 yrs Female	RDD	Charcoal	11	36.5	82.5	20.3	394	8.9	11.7	Sertraline 200 mg and clonazepam 0.5 mg	
3) 34 yrs Female	MDD	Chalk	12	35.7	81	11.8	316	9.1	12.3	Desvenlafaxine 150 mg and bupropion 150 mg	
4) 14 yrs Female	MDD	Wall plaster	11	36	87	13.5	355	8.9	10.2	Fluoxetine 20 mg and behavioral therapy	

Case 2

A 34-year-old married Hindu woman, from a rural nuclear family of middle socioeconomic status, presented with severe depression without psychotic symptoms in a background of recurrent depressive disorder with frequent conversion episodes over the last 5 years. The current depressive episode was associated with anxiety, agitation, anorexia, and a strong desire to smell stored charcoal in the household. That habit of smelling charcoal started almost at the same time of the affective symptoms during this episode. She emphasized the need of this behavior to diminish her anxiety. She used to smell for 5–10 minutes almost daily. However, she did not face much problem while refraining from this behavior. Her family members, including her husband, were unaware of such a habit.

She was thoroughly investigated, and all the blood parameters, including the iron profile, were within the normal range [Table 1]. She was prescribed sertraline 100 mg and clonazepam 0.5 mg. Sertraline was increased to 200 mg, while clonazepam was stopped gradually. She responded well, and both the depressive symptoms and the olfactory craving gradually subsided within 6 weeks of initiation of treatment.

Case 3

A 35-year-old married woman, from an urban nuclear family of upper socioeconomic status, presented with severe depressive episode without psychotic symptom for the preceding 1 year. She reported craving of smelling chalks and clay for the last 8 months with a frequency of 2–3 times per week at the peak. She never ingested the materials. She did not disclose it to her husband or son for the fear of embarrassment. She did not face any distressing symptoms on stopping smelling for any reason. There was no history of substance use or psychiatric illness in the family.

Thorough investigations revealed that the parameters, including serum level of calcium, zinc, and iron profile, were within normal limits [Table 1]. She underwent a trial of escitalopram at a dosage of 20 mg; however, notable amelioration of symptoms was not observed. Subsequently, she was prescribed desvenlafaxine. With combination therapy of desvenlafaxine 150 mg and bupropion 150 mg, both the depressive and desiderosmic symptoms subsided subsequently.

Case 4

A 14-year-old girl, living with her working parents in a middle-income rural nuclear family, presented with severe depressive episode without psychotic symptom for the last 6 months with excessive use of Internet in cellular phone (>8 hours/day). There was a history of predominant agitation and irritability. She displayed a strong desire to scrap off and smell the wall plaster and became agitated whenever resisted for the last 2 months. When confronted and reprimanded by her parents upon discovery, she would retreat to her room and engage in the activity during moments of agitation. However, she did not exhibit this behavior while under supervision during her grounding.

She had been examined and investigated thoroughly. The blood parameters, including iron, zinc, and calcium, were within the normal range [Table 1]. The psychometric assessment revealed that she had cluster B personality traits. She was treated with combination therapy of fluoxetine 20 mg and cognitive behavior therapy. After 3 months of the treatment, she showed marked improvement of both depression and the aforementioned behavior.

DISCUSSION

The term “desiderosmia” was coined using linguistic roots from two perspectives. Latin word “desiderare,” denotes desire, while the Greek word “osme,” signifies smell. The term “desidero,” represents iron deficiency.[1] Whether iron deficiency is the sole etiology behind behaviors, such as pica, desiderosmia or tactile chew craving is debatable.[3] There are articles regarding pica suggesting other mechanisms, but there is a dearth of literature in cases of desiderosmia.[1234]

The cases described in this study were comparable to the existing literatures in many aspects.[12] Unlike prior reports, none of them showed any abnormalities in their serum iron profile. Even the adolescent girl reported in the fourth case did not exhibit any such deficiency. The substances that the patients used to smell did not belong to any category of inhalants which may result in addictive behavior. None of them had fulfilled criteria of substance use disorders. The cases depicted such behavior as occasionally serving as a coping mechanism with distress, while at other times, it elicited feelings of shame. Intriguingly, in each case, the onset of a depressive episode preceded this behavior. The intensity and frequency of smelling such materials may subjectively be correlated with the severity of depression. These findings may open avenues into understanding the mechanism of such craving behavior. Whether depression can be seen as an association with desiderosmia is certainly an area of further research.

Interestingly, addressing the underlying depression resulted in the improvement of patients with desiderosmia of all four cases, illuminating a potential avenue for future research into its causes and treatments.

CONCLUSION

In this study, we tried to emphasize the role of identification of background psychiatric disorders in behaviors, such as desiderosmia, so that prompt psychiatric intervention can improve the outcome of this strange behavior. It needs further research to understand the association between depression and desiderosmia.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
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REFERENCES

1. Hansen BR Bottner WA Ravindran A DeJesus R Go RS Desiderosmia (olfactory craving): A novel symptom associated with iron deficiency anemia Am J Hematol 2017 92 E93 4 28240803
2. Yanardag AD Recognizing the unusual findings: Cases of desiderosmia Clin Case Rep 2019 7 953 4 31110722
3. Scheckel CJ Yanardag AD Ravindran A Marshall A Go R Hapticophagia: Tactile chew cravings in iron deficiency anemia Am J Hematol 2020 95 E107 8 32022318
4. Kettaneh A Eclache V Fain O Sontag C Uzan M Carbillon L Pica and food craving in patients with iron-deficiency anemia: A case-control study in France Am J Med 2005 118 185 8 15694906
