Anorexia Nervosa: Pharmacologic Treatments

Anorexia Nervosa: Pharmacologic Treatments

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Anorexia Nervosa: Pharmacologic Treatments


Medical Treatments: The Basics

Anorexia nervosa has been recognized by physicians for more than a century, but there is still no generally accepted pharmacologic treatment. Anorexia Nervosa can lead to significantly impaired functioning in its victims along with a considerable morbidity. The pursuit of thinness is the central feature of AN, and the patients usually have a variety of other psychological disorders which makes treatment very challenging and difficult. No medication has proven to be generally useful in promoting or maintaining weight gain, thus cognitive-behavioral therapy remains the cornerstone of treatment. (Hoffman et al)

According to Dr. Philip W. Long, "A therapist must win the cooperation of the patient by emphasizing that treatment can free the patient from the obsessive thoughts about food and body weight that have become the sole focus of the patient's life." In addition, depression, physical well-being, and social relationships can be improved through various treatments.

(http://www. mentalhealth.com/rx/p23-et01.html#Head_1c)

Pharmacology in the Treatment of Anorexia Nervosa

Many medications have been used in the treatment of Anorexia Nervosa. Of these different pharmacological treatments, there have been very few large scale, controlled studies demonstrating their effectiveness. Several of these medications, however, have proved useful in facilitating weight gain during the nutritional rehabilitation phase of treatment. This website discusses these different treatments, explains why they were used and their possible side effects, and the overall validity of their effectiveness as a treatment.

Antipsychotic Drugs

The most common form of this drug which is administered to AN patients is chlorpromazine. If prescribed, it is usually given to severely obsessive-compulsive, anxious, and agitated AN patients. This drug is a neuroleptic or dopamine antagonist in the brain, and the theory which serves as the basis of this treatment revolves around the idea that certain characteristics of anorexia nervosa might reflect central nervous system dopaminergic activity. Some scientists theorize that these dopaminergic activities cause this eating disorder among other things. In certain clinical experiences, chlorpromazine has been shown to be somewhat effective in inducing hunger and weight gain, but others have shown no such effects along with some serious side effects. These include grand mal seizures and in increase in the development of bulimia.

In summary, there is an absence of clear evidence as to the effectiveness of this drug as a treatment and with its potential for unwanted side effects, it is rarely used. (Walsh and Devlin)

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Antidepressants

A strong tie between anorexia nervosa and depression has been established for years. Malnutrition, emaciation, a distorted body image, a perfectionist family and a myriad of other conditions can produce a psychological profile which enmeshes anorexia nervosa and depression. Moreover, depression occurs far more frequently in anorectic patients than in the general population. Thus, many antidepressants have been shown to be an effective component of the overall treatment of certain anorectics.

Tricyclic antidepressants, such as clomipramine and amitriptyline, have been prescribed to anorectics. In different studies comparing them to placebo drugs, little significant differences between them were found. When dosages were raised, there was a faster bodyweight gain than with placebo, but the medication produced problematic adverse effect including sedation, tachycardia, constipation, dry mouth and confusion. (Crow & Mitchell 375)

Mixed reviews have also been found with cyproheptadine (an antihistimine and seratonin antagonist). Basic research has suggested that central seratonin systems are important in the regulation of feeding behavior. In brief, increased availability of seratonin in the hypothalamus tends to decrease food consumption. Therefore, this seratonin antagonist should be useful in increasing caloric intake. Of four major studies done by various doctors, only two showed modest benefits from active medication. This drug, however, significantly slowed the recovery of the bulimic subgroup of patients with Anorexia Nervosa. (Crow & Mitchell 376)

Flouxetine, another inhibitor of serotonin re-uptake, has been proven effective in the treatment of obsessive-compulsive disorder as well as depression. Different studies have shown that those patients who were administered flouxetine not only experienced an improvement in their depression but most gained weight as well. There are little if any side effects associated with this drug, and studies are pending as to its overall efficacy. (Hoffman & Halmi 769) A study done in 1991 by the University of Pittsburgh showed that flouxetine may help patients with anorexia nervosa maintain a healthy body weight as outpatients by improving eating behavior and/or reducing obsessionality, depression, and anxiety. It is stressed, however, that fluoxetine should not be used as the sole treatment. (Kaye et al.)

Other Drugs

Cisapride & Erythromycin- In primary anorexia nervosa, gastric motility is often impaired and ensuing symptoms further discourage eating. These drugs accelerate gastric emptying and thereby enhance gastric motor activity, thus alleviating the symptoms of gastric retention and changing eating behavior. There has been some clinical evidence of this theory, but it has not been proven to be totally effective. (Stacher et al)

Zinc Supplementation- Zinc Supplementation of anorexia nervosa has been reported to increase the weight gain of patients. This theory regarding the supplementation of zinc came about because of its association with weight loss, disorders of appetite and food intake, skin abnormalities, amenorrhea, and depression;the population most at risk for anorexia nervosa. Studies have shown that zinc supplementation of anorexia nervosa patients improved their weight gain and because of its low cost and low potential for side effects, it is a viable supplement to be considered with standard treatment. (Birmingham et al)

Summary

Many medications may be useful in treating certain patients with anorexia nervosa and its associated psychological disorders. However, it is difficult to predict who should receive which medication and how effective it will be. Furthermore, the potential for serious side effects must be carefully considered for patients who are very sick and emaciated. The importance of a comprehensive plan (family, behavioral, etc.) is the key here as no pharmacological treatment has been proven to be a cure for anorexia nervosa. In patients who have failed many other treatments, however, it is worthwhile to consider drug intervention a part of this comprehensive treatment plan.


Works Cited:

Hoffman,L. and Halmi, K., Psychopharmacology in the treatment of anorexia nervosa and bulimia nervosa, Psychiatric Clinics of North America. 16(4):767-78, 1993 Dec.

http://www.mentalhealth.com/rx/p23-et01.html#Head_1c

Walsh, B.T. and Devlin, MJ., The pharmacological treatment of eating disorders, Psychiatric Clinics of North America. 15(1):149-60, 1992 Mar.

Crow, SJ. and Mitchell, JE., Rational therapy of eating disorders, Drugs. 48(3):372-9, 1994 Sep.

Kaye WH., Weltzin TE., Hsu LK., and Bulik CM., An open trial of fluoxetine in patients with anorexia nervosa, Journal of Clinical Psychology. 52(11):464-71, 1991 Nov.

Stacher G., Abatzi-Wenzel TA., Wiesnagrotzki S., Bergmann H., Schneider C., Gaupmann G., Gastric emptying, body weight and symptoms in primary anorexia nervosa, British Journal of Psychiatry. 162:398-402, 1993 Mar.

Birmingham CL., Goldner EM., Bakan R., Controlled trial of zinc supplementation in anorexia nervosa, International Journal of Eating Disorders. 15(3):251-5, 1994 Apr.
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