Psychotropic medications in adult and adolescent eating disorders: clinical practice versus evidence-based recommendations

Garner, David M.; Anderson, Michael L.; Keiper, Christopher D.; Whynott, Rachel M.; Parker, Lauren

doi:10.1007/s40519-016-0253-0

Cited by 24 publications

(22 citation statements)

References 22 publications

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“…Broadly, most published literature based on randomized controlled trials has concluded that SSRIs offer no more benefit than placebo, yet they are used very frequently (Fazeli et al, 2012;Garner et al, 2016). Research has demonstrated clear links between AN and serotonergic activity (e.g., Bailer et al, 2013), but it is yet unclear how, when, or for whom SSRI medication is most effective.…”

Section: Approximately 4 Months Later Patient A's Mother Reported Thatmentioning

confidence: 99%

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Relapse prevention and selective serotonin reuptake inhibitor medication in two adolescents with anorexia nervosa

Luzier

Rached

Talley

2019

Intl J Eating Disorders

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Objective: Clinicians and researchers have long struggled to find effective treatments for people with anorexia nervosa (AN). Although most clinical guidance suggests that selective-serotonin reuptake inhibitor (SSRI) medication is not an effective first-line treatment for AN, in practice, these medicines continue to be frequently prescribed for comorbid diagnoses.Method: In this case report, two adolescents who were in sustained remission from AN either relapsed or began to decline significantly once their dose of SSRI medication was tapered.Results: In Case A, despite a very slow and measured taper, this child dropped significant weight in a short amount of time after the medication was discontinued. Fortunately for Case B, symptoms emerged before the taper was complete, and providers could quickly increase the dose of medication early in her struggle with AN thoughts and urges.Discussion: A brief review of literature regarding SSRI medication use in AN is presented along with considerations for future research.K E Y W O R D S adolescent, anorexia nervosa, eating disorder, medication, relapse

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Section: Approximately 4 Months Later Patient A's Mother Reported Thatmentioning

confidence: 99%

“…Despite these evidence-based recommendations, one study found that 78.7% of adolescents in a residential adolescent treatment program and 89.6% of adults in an adult partial hospitalization program were prescribed psychotropic medications, most frequently antidepressants (Garner, Anderson, Keiper, Whynott, & Parker, 2016).…”

Section: Introductionmentioning

confidence: 99%

Relapse prevention and selective serotonin reuptake inhibitor medication in two adolescents with anorexia nervosa

Luzier

Rached

Talley

2019

Intl J Eating Disorders

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“…19 - 21 Bupropion is contraindicated due to increased risk of seizures in anorexic patients. 19 , 21 , 28 Garner et al 29 reported that antidepressants are widely prescribed to adults and adolescent anorexic patients despite recommendations in treatment guidelines. Antidepressants were commonly prescribed to 87.9% of studied individuals (n = 287, age = 23.2 ± 10.4 years, BMI = 16.5 ± 1.6) with 79% receiving a selective serotonin reuptake inhibitor (SSRI).…”

Section: Introductionmentioning

confidence: 99%

“…Antidepressants were commonly prescribed to 87.9% of studied individuals (n = 287, age = 23.2 ± 10.4 years, BMI = 16.5 ± 1.6) with 79% receiving a selective serotonin reuptake inhibitor (SSRI). 29 This article discusses the safety of different antidepressants in AN and summarizes recent evidence and highlights potential benefits of use of select SSRIs and mirtazapine in adult anorexic patients during acute and maintenance treatment phases.…”

Section: Introductionmentioning

confidence: 99%

Role of antidepressants in the treatment of adults with anorexia nervosa

Marvanová

Gramith

2018

Mental Health Clinician

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Introduction:Anorexia nervosa (AN) is a severe psychiatric disorder that is difficult to treat and is associated with frequent relapses and high mortality rates. Psychiatric symptomatology (eg, depression, anxiety, obsessive-compulsive disorder/behaviors) are common comorbidities. This review provides current information about safety and efficacy of antidepressant therapy for management of AN in adults.Methods:A literature review of randomized controlled trials, open-label studies, and case reports with adults or adults/adolescents was conducted. PubMed and Medline were searched using anorexia management and treatment, antidepressants, selective serotonin reuptake inhibitors (SSRIs), fluoxetine, sertraline, citalopram, and mirtazapine in AN, relapse prevention in AN, and psychotropic medications in AN.Results:The role and utility of antidepressants in AN were published in double-blind, placebo-controlled studies; open-label trials; and a retrospective study. Antidepressants should not be used as sole therapy for AN although their use for confounding symptomatology makes discerning efficacy difficult as they are given together with other therapies. Neurobiological changes due to starvation and AN itself complicate results interpretation. For safety, tricyclic antidepressants and monoamine oxidase inhibitors are not recommended, and bupropion is contraindicated. Use of SSRIs during acute treatment lacks efficacy. Use of SSRIs—primarily fluoxetine and to some extent citalopram, sertraline, or mirtazapine—may aid in relapse prevention and improvement of psychiatric symptomatology in weight-restored anorexic patients.Discussion:Health care professionals should use clinical judgment regarding fluoxetine or possibly citalopram, sertraline or mirtazapine as adjunctive treatment to psychotherapy for relapse prevention, improvement of depressive and anxiety symptoms, and/or obsessive-compulsive behaviors unresolved with nutritional rehabilitation and psychotherapy.

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“…There were 506 females (280 PHP and 226 RES) and 29 males (11 PHP and 18 RES). The majority of patients were admitted on at least one psychotropic medication [18]. The retrospective chart review was approved by the Clinic Institutional Review Board and it was determined to comply with the Health Insurance Portability and Accountability Act guidelines.…”

Section: Introductionmentioning

confidence: 99%

The Disconnect between Treatment Outcome Data and Reimbursement for the Treatment of Anorexia Nervosa

Garner¹

2016

Int J Physiatry

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A major problem plaguing the discussion of insurance reimbursement for the treatment of anorexia nervosa is the apparent gap between research on variables associated with outcome and the formulas used for reimbursement. Outside of the mental health world, insurance coverage is driven by advanced analytics and actuarial data. However, in calculating insurance reimbursement for the treatment of anorexia nervosa, actuarial data associated with short-term and long-term outcomes are not utilized. Insurers typically focus on length of stay and daily rates in decision-making regarding preferred providers. However, it is possible to calculate the costs and effectiveness of treatment much more precisely by comparing treatment providers against benchmarks such as rate of weight gain and discharge body weight published in the literature. Providers should be encouraged to publish admission and discharge BMIs along with daily reimbursement rates to allow consumers and insurers to evaluate the cost effectiveness of treatment. where most of the effectiveness data could be gathered, treatment providers are fortunate if they are able to collect reimbursement for treatment actually provided. It is unheard of for insurers to offer compensation for collecting long-term follow-up data. Nevertheless, in these settings it is possible to assess specific pre-post variables

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Psychotropic medications in adult and adolescent eating disorders: clinical practice versus evidence-based recommendations

Cited by 24 publications

References 22 publications

Relapse prevention and selective serotonin reuptake inhibitor medication in two adolescents with anorexia nervosa

Relapse prevention and selective serotonin reuptake inhibitor medication in two adolescents with anorexia nervosa

Role of antidepressants in the treatment of adults with anorexia nervosa

The Disconnect between Treatment Outcome Data and Reimbursement for the Treatment of Anorexia Nervosa

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