Pharmacotherapy/ Medication Therapy for Anorexia Nervosa
Posted Sep 22 2008 5:37pm
In the last post, we took a look at some of the medications currently in use for bulimia nervosa and binge eating. Today, let's explore some pharmacotherapy issues with regard to the treatment of anorexia nervosa.
As for prescription medication, there is sparse evidence as to the effectiveness of pharmacotherapy interventions in malnourished anorexia patients. There are currently no agents approved by the FDA for the treatment of anorexia nervosa.
However, recent studies have yielded some promising data with regard to off-label use of certain mediations. Several atypical anti-psychotic agents, including olanzapine, quetiapine, and aripiprazole have demonstrated a moderate effect on weight gain in anorexia patients, coupled with a reduction in food related obsessions, agitation and anxiety.
Benzodiazapines have also been shown to reduce food-related and meal-time anxiety, but should be used on a time-limited basis and with caution in patients with a history of substance abuse.
Selective Serotonin Re-uptake Inhibitors (SSRIs) have not demonstrated effectiveness for weight restoration, nor have they proven to be effective for co-occurring conditions during the weight restoration phase of anorexia nervosa. However, SSRIs may reduce binge behaviors and be efficacious for related issues after weight a patient's has been restored. There has not been a consensus as to the benefits of tricyclic antidepressants for anorexia nervosa, although some data show a mild to moderate benefit.
Cautions for medication use with anorexia patients include the high rate of suicide, habit forming nature of certain medications, and cardiac side effects. Renal and cardiac concerns pose contraindications for the use of lithium, and the same caution for use of bupropion with bulimia patients applies to anorexia patients as well (see post dated August 14, 2008). In addition, there is strong indication that pharmacotherapy in the absence of psychotherapy with anorexia patients should be avoided.
Finally, it should not go without saying that studies show that the best treatment for anorexia nervosa is adequate nutrition - simply put, food is the best medicine for anorexia patients. In a future post, I will detail more about this as it relates to scientific findings. However, for now, suffice it to say that many of the symptoms related to anorexia nervosa are in fact the result of starvation and malnutrition. Therefore, adequate nutrition and weight restoration remain the best intervention.