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.Br.J.Nutr., 88: 183 188. _________________________________________________________________________________________________ CHAPTER_________________________4Pharmacological Treatmentof Eating Disorders:A ReviewMartina de ZwaanDepartment of General Psychiatry, University Hospital of Vienna,Austria, and Department of Neuroscience,University of North Dakota School of Medicine and Health Sciences,Fargo, North Dakota, USAJames RoerigDepartment of Neuroscience,University of North Dakota School of Medicine and Health Sciences,Fargo, North Dakota, USAINTRODUCTIONThis review explores the literature concerning the pharmacologicaltreatment of anorexia nervosa, bulimia nervosa and binge eating disorder(BED), emphasizing controlled investigations that utilize a wait-listcontrol condition or other comparison sample.Each type of eatingdisorder will be reviewed separately.Controlled treatment studies have,for the most part, been conducted on bulimia nervosa.Recently, moreattention has been devoted to evaluating the drug treatment of BED.Because relatively less treatment outcome research has been conductedon anorexia nervosa, we will also discuss some of the uncontrolledpsychopharmacological studies.These data will aid the clinician inchoosing treatments that have clear support for their use and, inaddition, enable the clinician to identify when the standard treatmentshave been exhausted and when a wider exploration of possible solutionsto refractory patients is required.Eating Disorders.Edited by Mario Maj, Katherine Halmi, Juan José López-Ibor and Norman Sartorius.&2003 John Wiley & Sons Ltd: ISBN 0-470-84865-0 224 ___________________________________________________________________________ EATING DISORDERSANOREXIA NERVOSAThe use of pharmacotherapy in anorexia nervosa remains controversialtoday.Research in this area is difficult owing to a variety of factors,including the relatively low prevalence (0.1%) of anorexia nervosa, and thefact that acutely ill anorexic patients have a potentially life-threateningillness that often makes research unadvisable.In addition, patients withanorexia nervosa show a marked resistance and ambiguity about treatment.In light of the seriousness of the illness, the majority of studies are inpatientin nature and virtually all the pharmacotherapy data involve the addition ofthe experimental treatment modality to usual care , which in somecircumstances may include intensive weight restoration programmes.Thusthe risk of a ceiling effect masking any drug effect is possible.As for mostdisease states, a relatively large number of case reports, case series and openlabel studies raise hopes for significant efficacy of a variety of treatments.However, attempts to confirm these reports with placebo-controlled,double-blind randomized trials tempers the enthusiasm considerably.In choosing outcome criteria, the most relevant results in anorexianervosa are improved eating, weight gain and, later, maintenance of weightgain.Additional outcomes may be instructive, including changes of bodyimage attitudes, fears and beliefs, as well as alterations in comorbidconditions such as depression, anxiety and obsessive compulsive symp-toms.AntidepressantsThe use of antidepressant pharmacotherapy in anorexia nervosa has beenexplored since the 1980s with varying results.Trials with antidepressantswere prompted by the observation that many patients with anorexianervosa have depressive symptoms and there is an increased risk for majordepression in first-degree relatives of eating disorder patients.Table 4.1 liststhe uncontrolled reports of antidepressant use.Because there are only a fewcontrolled studies available, we have to turn to open trials for clues torational pharmacological management of anorexia nervosa.Interestingly,all the uncontrolled trials focus on selective serotonin reuptake inhibitors(SSRIs), specifically fluoxetine, citalopram and sertraline, with two studiescomparing fluoxetine to nortriptyline and amineptine and one studycomparing fluoxetine to venlafaxine.As with tricyclic antidepressants(TCAs), treatment with SSRIs is based on the findings that patients withanorexia nervosa frequently exhibit depressive symptoms.However, SSRIsmay also act by affecting obsessive compulsive symptomatology.Inaddition, dysfunction of the serotonergic system has been postulated as a TABLE 4 [ Pobierz caÅ‚ość w formacie PDF ] |
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