Role of antidepressants in the treatment of adults with anorexia nervosa

Abstract

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.

Pharmacological treatment of acute-phase anorexia nervosa: Evidence from randomized controlled trials

“…In subsequent years, other literature reviews have been published, focused either on a specific pharmacological class (e.g. ‘antidepressants’, ‘antipsychotics’) (Dold et al, 2015; Marvanova and Gramith, 2018), or did not rigorously select RCTs, including studies with less rigorous methods (Marvanova and Gramith, 2018; Miniati et al, 2016). In the last decade, psychopharmacology has been enriched with the release of new molecules (e.g.…”

“…Several hypotheses could further explain the fact that pharmacotherapy does not have any significant effect on AN. Some authors suggested that the state of malnutrition present in patients suffering from AN could compromise the functioning of antidepressant drugs, because of alterations in serotonin metabolism caused by diminished circulating tryptophan and gonadal steroids (Ferguson et al, 1999), and of structural and functional brain changes (Marvanova and Gramith, 2018). Additionally, the results of the studies carried out with neuroimaging techniques on patients with AN suggest the presence of alterations at the level of the dopaminergic system, such as an altered sensitivity to the D2 receptor, a decrease in intrasynaptic dopamine, or an altered density of D2/D3 receptors (Phillipou et al, 2014).…”

Eating disorders and oral health: a scoping review on the role of dietitians

“…Significant relationships between poorer self-reported oral health outcomes, lower socioeconomic status and mental health vulnerabilities were also noted [ 22 – 24 ]. Specifically for individuals with a mental health condition, barriers to maintaining oral health included a reduced awareness of the presence/risk of oral health problems, the affect of medications such as antidepressants resulting in manifestations such as dry mouth, lower self-esteem and body image, poor diet and fear and distrust of dental providers [ 24 – 26 ]. Although individuals with ED were generally found to be concerned about their teeth especially the long term impact of dental issues such as enamel erosion [ 27 , 28 ], their perceived barriers for not seeking dental intervention included reduced energy levels, anxiety, uncertainty about oral hygiene and distrust of dental providers [ 27 , 28 ].…”

Developmental fluoxetine exposure in zebrafish reduces offspring basal cortisol concentration via life stage-dependent maternal transmission

“…As the first SSRI on the market, fluoxetine (FLX), originally marketed as Prozac [24], continues to be prescribed as generic pharmacological treatment for major depression, as well as additional conditions such as obsessive-compulsive disorder [25], anxiety [26], pre-menstrual dysphoric disorder [27], and eating disorders [28]. FLX remains the most studied SSRI with regard to both human health [29] and aquatic toxicology [30].…”