Pharmacotherapy of eating disorders

Abstract

Although pharmacotherapy has established utility in bulimia nervosa and BED, further research on medications for the treatment of eating disorders, particularly anorexia nervosa, is necessary.

Psychopharmacological advances in eating disorders

“…In the 2000s and 2010s, the idea of treating EDs with antipsychotics was also revived, because second-generation antipsychotics became available. For example, an increasing amount of evidence has been gathered from RCTs [26][27][28][29] (for review see [30]) and clinical observations (for example [31]) showing that olanzapine may be helpful to treat symptoms of AN.…”

“…The atypical antipsychotic olanzapine, an antagonist at serotonin and dopamine receptors, is of interest as a treatment option for AN [26][27][28][29][30][31]113]. It has been reported to lead to weight gain in patients with schizophrenia [114] on the basis of its high affinity towards the histaminergic H1 receptor and its antihistaminergic action [115].…”

“…Currently discussed psychopharmacological agents to treat for AN include atypical antipsychotics, the cannabinoid receptor (CB) agonist dronabiol and D-cycloserine [30]. A recent systematic review to summarize evidence from research on psychopharmacological options for adult patients with AN [8], however, came to the conclusion that the body of evidence for the efficacy of pharmacotherapy in AN was unsatisfactory, because the quality of observations was questionable, and sample size was often small.…”

Editorial: New Perspectives to Unlock the Current Impasse in Treating Anorexia Nervosa

“…Pharmacological treatment has failed to offer a more optimistic picture regarding AN treatment (Davis and Attia, 2017). However, at variance with pharmacotherapy whose action is more loosely connected to aetiological or maintenance factors, psychological treatments mainly focus on different conceptualizations of AN.…”

Facets of shared decision-making on drug treatment for adults with an eating disorder

“…explain in an intelligible manner that scientific literature suggests that olanzapine is the atypical antipsychotic with the highest likelihood to restore weight and treat important psychological and emotional symptoms in patients with AN in a safe manner: i) olanzapine was superior to placebo with regard to weight gain in four published RCTs(Kafantaris et al, 2011, Brambilla et al, 2007, Bissada et al, 2008, Attia et al, 2011) and in one not yet published but recently completed large, multisite RCT in patients with AN (mentioned inDavis & Attia, 2017); ii) olanzapine may be the most efficacious of antipsychotics examined for the treatment of AN due to its known beneficial influence on anxiety(Tollefson & Sanger, 1999;Temmingh & Stein, 2015) and sleep(Kluge et al, 2014); and iii) it affects the serotonergic, dopaminergic and histaminergic neurotransmission and thus may have a beneficial effect on the self-regulatory, the hedonic and the homeostatic system which have all been shown to play a crucial role in the pathophysiology of EDs.During SDM, the clinicians should also share information on how treatment success will be measured. Using the example of olanzapine treatment for AN, treatment outcomes could be the BMI, ED and general psychopathology, treatment adherence, and patient and carer quality of life.…”