“Pica” is the term used to describe craving for non-food and nonnutritive
items like dirt, chalk, or paper. Pagophagia (compulsive ice
chewing) is a particular form of pica that is characterized by ingestion
of ice, freezer frost, or iced drinks. It is usually associated with iron
deficiency anemia or mental abnormalities like intellectual disabilities,
autism, etc. Very few case reports have reported association of eating ice
cubes with compulsive behavior or depressive disorders. In this case report,
we present the association of pagophagia with sadness in a patient
with recurrent depressive disorder. A 44-year-old female suffering from
depressive disorder since the age of 33 years presented with symptoms
of an intense desire to eat ice cubes that she was unable to resist and
would feel better only after consumption of ice cubes or iced drinks.
Initially she would consume about 250–500 g of ice cubes per day, but
gradually the quantity of consumption of ice increased to about 10–12
kg of ice cubes per day. These symptoms were related to low mood
and stress. The preoccupation with consumption of ice was associated
with significant psychosocial dysfunction and interpersona problems
with the spouse. She was managed with venlafaxine 187.5 mg/day and
cognitive behavior psychotherapy (identifying her cognitive errors, generating
alternative thoughts, problem solving, activity scheduling and
mastery, and pleasure technique) with which her depressive symptoms
improved and her pagophagia reduced significantly but did not subside
completely. She learned to use alternative coping mechanisms to deal
with her psychosocial stressors.