Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews

Abstract

Drugs are widely prescribed for anorexia nervosa in the nutritional, somatic, and psychiatric fields. There is no systematic overview in the literature, which simultaneously covers all these types of medication. The main aims of this paper are (1) to offer clinicians an overview of the evidence-based data in the literature concerning the medication (psychotropic drugs and medication for somatic and nutritional complications) in the field of anorexia nervosa since the 1960s, (2) to draw practical conclusions for everyday practise and future research. Searches were performed on three online databases, namely MEDLINE, Epistemonikos and Web of Science. Papers published between September 2011 and January 2019 were considered. Evidence-based data were identified from meta-analyses, if there were none, from systematic reviews, and otherwise from trials (randomized or if not open-label studies). Evidence-based results are scarce. No psychotropic medication has proved efficacious in terms of weight gain, and there is only weak data suggesting it can alleviate certain psychiatric symptoms. Concerning nutritional and somatic conditions, while there is no specific, approved medication, it seems essential not to neglect the interest of innovative therapeutic strategies to treat multi-organic comorbidities. In the final section we discuss how to use these medications in the overall approach to the treatment of anorexia nervosa.

Short-term metreleptin treatment of patients with anorexia nervosa: rapid on-set of beneficial cognitive, emotional, and behavioral effects

“…Thus, whereas drugs such as e.g. antidepressants 42 and antipsychotics 43 are widely prescribed for symptoms of AN, including hyperactivity 44,45 , the evidence-base for their effectiveness is meagre 2,42,43,46 .…”

A Randomized Trial of Deep Brain Stimulation to the Subcallosal Cingulate and Nucleus Accumbens in Patients with Treatment-Refractory, Chronic, and Severe Anorexia Nervosa: Initial Results at 6 Months of Follow Up

“…Morphological and functional studies in patients with AN have shown alterations in insular activity and in the prefrontal cortex, orbitofrontal, temporal, parietal, anterior cingulate, and ventral striatum (nucleus accumbens, NAcc) [ 18 , 19 , 20 ]. The available evidence suggests that the two most relevant targets for the surgical treatment of AN appear to be the NAcc [ 21 ] and the subcallosal cingulate (SCC), mainly due to the substantial involvement of these two structures in the reward circuits, but also because these two areas serve as communication links between the limbic and cortical systems [ 7 , 9 ].…”

Brain Stimulation in Eating Disorders: State of the Art and Future Perspectives

“…Although the level of evidence is low, ECT may be useful and safe for the management of severe and treatment-resistant MDD in patients with AN. Its wider accessibility compared to other brain stimulation techniques should facilitate the organization of a prospective trial, particularly in patients with severe comorbid MDD, given the lower efficacy of SSRI in AN [5]. The cognitive and memory effects of ECT are a challenging aspect.…”

“…Starvation and nutritional status affect behavior, cognition, and disease symptoms. The nutritional status also influences the treatment response, especially to antidepressants that are less effective in acutely ill and underweight patients [5]. To the best of our knowledge, no study has determined whether the nutritional status affects the resting brain state and the neuromodulatory response.…”

“…However, data to guide the psychotherapy choice are limited and controversial [ 4 ]. Medication trials have been disappointing [ 5 ]. Overall, about one-third of patients will not recover, and the standardized mortality rate is 5.9 [ 6 ].…”