The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects

Frank, Guido; Shott, Megan E.

doi:10.1007/s40263-016-0335-6

Cited by 49 publications

(76 citation statements)

References 185 publications

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“…The subcutaneous mode of application may also have promoted expectation effects. However, for the following reasons we consider it highly unlikely that such effects in total explain our results: (i) In general, AN is one of the most difficult disorders in psychiatry to treat 2,59 ; particularly achievement of weight gain is notoriously challenging in this disorder 4,60 . In clinical terms, we are unaware of any evidence for the occurrence of pronounced expectation effects in acutely ill patients.…”

Section: Discussionmentioning

confidence: 98%

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

et al. 2020

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To examine the hypothesis that normalization of low circulating leptin levels in patients with anorexia nervosa ameliorates hyperactivity, three seriously ill females with hyperactivity were treated off-label with metreleptin (recombinant human leptin) for up to 14 days. Drive for activity, repetitive thoughts of food, inner restlessness, and weight phobia decreased in two patients. Surprisingly, depression improved rapidly in all patients. No serious adverse events occurred. Due to obvious limitations of uncontrolled case series, placebo-controlled clinical trials are mandatory to confirm the observed rapid onset of beneficial effects. Our findings suggest an important role of hypoleptinemia in the mental and behavioral phenotype of anorexia nervosa.

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Section: Discussionmentioning

confidence: 98%

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

et al. 2020

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“…For example, the lack of efficacious pharmacological interventions specifically for AN might be due to a relative lack of insight about the biological mechanisms underlying it. [7][8][9] The fact that there is no clearly superior psychosocial intervention among a wide range of interventions for adults and adolescents with AN is also particularly concerning. 10 Despite the poor mechanistic knowledge of ED, an extensive body of literature has investigated putative risk factors for ED, testing a wide range of environmental [11][12][13][14][15] and genetic [16][17][18][19][20] risk factors.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for eating disorders: an umbrella review of published meta-analyses

Solmi

Raduà

Stubbs

et al. 2021

Braz. J. Psychiatry

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Objective: To grade the evidence about risk factors for eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) with an umbrella review approach. Methods: This was a systematic review of observational studies on risk factors for eating disorders published in PubMed/PsycInfo/Embase until December 11th, 2019. We recalculated random-effect meta-analyses, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals, grading significant evidence (p o 0.05) from convincing to weak according to established criteria. Quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. Results: Of 2,197 meta-analyses, nine were included, providing evidence on 50 risk factors, 29,272 subjects with eating disorders, and 1,679,385 controls. Although no association was supported by convincing evidence, highly suggestive evidence supported the association between childhood sexual abuse and bulimia nervosa (k = 29, 1,103 cases with eating disorders, 8,496 controls, OR, 2.73, 95% CI 1.96-3.79, p = 2.1 x 10-9, AMSTAR-2 moderate quality) and between appearance-related teasing victimization and any eating disorder (k = 10, 1,341 cases with eating disorders, 3,295 controls, OR 2.91, 95%CI 2.05-4.12, p = 1.8x10-9, AMSTAR-2 moderate quality). Suggestive, weak, or no evidence supported 11, 29, and 8 associations, respectively. Conclusions: The most credible evidence indicates that early traumatic and stressful events are risk factors for eating disorders. Larger collaborative prospective cohort studies are needed to identify risk factors for eating disorders, particularly anorexia nervosa.

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“…Anorexia nervosa is a severe psychiatric disorder associated with food avoidance and life threatening weight loss that most commonly occurs in females (American Psychiatric Association, 2013). No medication has been approved for the treatment of anorexia nervosa (Frank & Shott, 2016). Basic science has suggested that dopamine receptor agonists support learning and behavior change in females who are underweight and in a low estrogen state (Frank, 2014).…”

Section: A R I P Ip R a Z O L E I N A N O R E X Ia N E R V O S Amentioning

confidence: 99%

“…No medication has been approved for the treatment of anorexia nervosa (Frank & Shott, 2016). Basic science has suggested that dopamine receptor agonists support learning and behavior change in females who are underweight and in a low estrogen state (Frank, 2014).…”

mentioning

confidence: 99%

The partial dopamine D2 receptor agonist aripiprazole is associated with weight gain in adolescent anorexia nervosa

Frank

Shott

Hagman

et al. 2017

Intl J Eating Disorders

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Objective Finding medication to support treatment of anorexia nervosa has been difficult. Neuroscience based approaches may help in this effort. Recent brain imaging studies in adults and adolescents with anorexia nervosa suggest that dopamine related reward circuits are hypersensitive and could provide a treatment target. Method Here we present a retrospective chart review of 106 adolescents with anorexia nervosa some of whom were treated with the dopamine D2 receptor partial agonist aripiprazole during treatment in a specialized eating disorder program. Results The results show that aripiprazole treatment was associated with greater increase in body mass index (BMI) during treatment. Discussion The use of dopamine receptor agonists may support treatment success in anorexia nervosa and should be further investigated.

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The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects

Cited by 49 publications

References 185 publications

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

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

Risk factors for eating disorders: an umbrella review of published meta-analyses

The partial dopamine D2 receptor agonist aripiprazole is associated with weight gain in adolescent anorexia nervosa

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