Psychopharmacological options for adult patients with anorexia nervosa

Abstract

The aim of this review was to summarize evidence from research on psychopharmacological options for adult patients with anorexia nervosa (AN). Database searches of MEDLINE and PsycINFO (from January 1966 to January 2014) were performed, and original articles published as full papers, brief reports, case reports, or case series were included. Forty-one papers were screened in detail, and salient characteristics of pharmacological options for AN were summarized for drug classes. The body of evidence for the efficacy of pharmacotherapy in AN was unsatisfactory, the quality of observations was questionable (eg, the majority were not blinded), and sample size was often small. More trials are needed, while considering that nonresponse and nonremission are typical of patients with AN.

A focus on reward in anorexia nervosa through the lens of the activity‐based anorexia rodent model

“…selective serotonin reuptake inhibitors [SSRIs]) or delusional dysmorphic features (dopamine‐directed; i.e. olanzapine or haloperidol) that often complicate the course of the disorder . Despite this, there is considerable evidence supporting altered CNS function in AN patients, particularly for disruptions in serotonin (5‐HT) and dopamine (DA) signalling.…”

“…Although a large body of research on anorexia has focused on serotonergic systems, therapeutic interventions targeting 5‐HT have had little success in treating the core symptoms of the disorder and may be more relevant to associated mood disturbances. 5‐HT is known to have a suppressive effect on food intake, and so it appears paradoxical that increasing the availability of 5‐HT with the use of SSRIs might promote survival of ABA.…”

“…olanzapine or haloperidol) that often complicate the course of the disorder. 5 Despite this, there is considerable evidence supporting altered CNS function in AN patients, particularly for disruptions in serotonin (5-HT) and dopamine (DA) signalling. It has been proposed that 5-HT may play a role in altered satiety, impulse control and mood disruptions in AN, whereas DA may be implicated in aberrant reward and motivation related to food and feeding.…”

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

“…However, randomized controlled trials (RCTs) often fail as a considerable number of patients with AN refuse to participate in an RCT or drop out prematurely. One of the problems facing psychopharmacological research in AN may be the reservations patients have regarding drug treatment in general, particularly for drugs which may increase weight (Miniati et al, 2016).…”

“…Usually, a decrease in EDs symptoms is considered a treatment goal. In AN, an increase in body mass index (BMI) and a decrease in AN symptoms are usually the goals of psychopharmacological treatment(Miniati et al, 2016;Dold et al, 2015). However, from a patient perspective, they may feel such a trial and such psychopharmacological treatment were just a way to speed up weight gain for the clinicians' benefit, rather than for helping their thinking and anxiety, and that numbers and weight is all that is important for those 'higher up' (Tyrrell-Bunge et al,2018).…”