Emerging drugs for eating disorder treatment

Abstract

Anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) comprise the currently recognised eating disorders. Although distinct diagnostic entities, they share certain forms of comorbid psychopathology, particularly anxiety and mood disorders. BN and BED have been studied most intensively as targets for pharmacotherapy. The list of drugs tested in eating disorders is substantial; however, the number of therapeutic classes of medications tested in these conditions is relatively modest. Antidepressant medications, including tricyclic antidepressants, selective serotonin re-uptake inhibitors, as well as some of the novel antidepressants, have shown evidence of some therapeutic value in both BN and BED. Their efficacy in AN, however, has been disappointing. The pharmacological options for AN are very limited. The number of controlled trials that have been conducted is small, and the research that has been successfully completed has generally failed to demonstrate medication efficacy. Patients with BN typically show reduced binge eating and purging frequency in medication trials, but rarely attain abstinence. In BED, patients often measure the value of their medication therapy by its ability to stimulate weight loss, which is another area on which future pharmacotherapy may improve. Novel pharmacological interventions are needed for each of these conditions. Peptide hormones are increasingly being evaluated for eating disorder treatment, including ghrelin agonists, neuropeptide Y1 and -5 antagonists, orexin receptor antagonists, corticotropin-releasing factor receptor 2 antagonists, histamine 3 antagonists, melanocortin 4 receptor antagonists, beta3-adrenoceptor agonists, 5-hydroxytryptamine-2A antagonists and growth hormone agonists. Although these compounds are in early phases of clinical testing for eating disorder treatments, data from these studies will be instructive in the quest for effective pharmacotherapy for these conditions. An overview of the current pharmacotherapy options for eating disorders is presented with a discussion of the emerging potential treatments.

Use of Psychopharmacologic Medications in Adolescents With Restrictive Eating Disorders: Analysis of Data From the National Eating Disorder Quality Improvement Collaborative

“…Similarly, studies investigating SSRI and atypical antipsychotic use in adults have also failed to demonstrate improvement in psychiatric symptom scores when compared to placebo or no medication [8,25,26]. A recent meta-analysis [14] of atypical antipsychotic use in adult patients with anorexia nervosa demonstrated no difference in body mass index improvement, an overall increase in anxiety symptoms, and a small decrease in depressive symptoms, when the medication group was compared to placebo.…”

Orexin-A Activates Hypothalamic AMP-Activated Protein Kinase Signaling through a Ca2+-Dependent Mechanism Involving Voltage-Gated L-Type Calcium Channel

“…Orexin-Astimulated hyperphagia plays an important role in the abnormal control of eating behavior in patients with eating disorders (Steffen et al, 2006;Baranowska et al, 2008;Bronsky et al, 2011). However, the precise molecular mechanism underlying orexin-A-stimulated eating behavior remains largely unknown.…”

Identification and Management of Eating Disorders in Children and Adolescents

“…129 Other drugs, including naltrexone and ondansetron (Zofran), are being used with some success in BN, although data are lacking to recommend their use more broadly. 130 Hormonal supplementation, although capable of restoring menstruation, has not been shown to reliably improve bone mineral density and is not a substitute for nutritional rehabilitation and restoration of positive energy balance.…”