Drug Therapy for Patients with Eating Disorders

Abstract

The purpose of this article is to review the psychopharmacology treatment literature for patients with eating disorders including bulimia nervosa, anorexia nervosa and binge eating disorder. The best-developed treatment literature concerns bulimia nervosa, which has been studied now in several dozen pharmacological treatment studies. The agents most commonly used are the antidepressants, with particular focus on the selective serotonin reuptake inhibitors including fluoxetine hydrochloride. These agents clearly impact significantly on the frequency of abnormal eating behaviors such as binge eating and purging. However, subjects treated with these drugs rarely achieve remission. Pharmacotherapy of anorexia nervosa has also traditionally focused on the use of antidepressants and there is some evidence that the use of SSRIs may help in preventing relapse in weight restored patients. Recently interest has developed in the use of atypical neuroleptics to help with the obsessionality and resistance to treatment frequently seen in low weight patients, the most commonly employed agent being olanzapine. Pharmacotherapy of binge-eating disorder is now being intensively investigated. In general medication alone seems inferior to psychotherapy in the short term. Antidepressants can increase the amount of weight loss when combined with psychological treatment and also appear to benefit symptoms such as depression. Further data are needed, but a number of drugs appear promising.

Topiramate treatment in bulimia nervosa patients: A randomized, double-blind, placebo-controlled trial

“…However, most of the patients treated with these drugs rarely achieve disease remission (Mitchell, de Zwaan, & Roerig, 2003). For this reason, interest in topiramate as a treatment for eating disorders, especially bulimia nervosa, has increased (Appolinario & McElroy, 2004).…”

Expression and activity of P‐glycoprotein (MDR1/ABCB1) in peripheral blood mononuclear cells from patients with anorexia nervosa compared with healthy controls

“…39 Thus, P-gp mediated drug efflux is an established mechanism limiting drug efficacy and causing treatment failure. We therefore tested the hypothesis, whether nonresponse to various psychotropic drugs in AN 18 might be related to changes in activity of P-gp in underweight patients with AN.…”

Intérêt de la nutrition entérale par sonde nasogastrique dans la boulimie

“…Les médicaments antidépresseurs de la famille des inhibiteurs de la recapture de la sérotonine ont fait également la preuve de leur intérêt sur la boulimie ellemême [2,[13][14][15]17] : ils diminuent ou stoppent les crises, et améliorent la qualité de vie, quand ils sont efficaces. Leur efficacité n'est pas réservée aux seuls malades dépressifs [15].…”

“…Certains malades ne peuvent pourtant la mener à bien. Les médicaments antidépresseurs de la famille des inhibiteurs de la recapture de la sérotonine ont prouvé leur efficacité à l'occasion d'études randomisées [14][15][16][17][18], mais ils ne sont efficaces qu'1 fois sur 2, et rarement avant 3 à 6 semaines. C'est dans ce contexte thérapeutique que nous avons ré analysé les résultats d'une étude antérieure : elle montrait que la nutrition entérale par sonde nasogastrique (NE) pouvait Ce qui était connu • La NE ambulatoire diminue nettement l'anxiété et l'état dépressif de ces malades, preuve qu'ils étaient en grande partie liés à la répétition des crises de boulimie elles-mêmes.…”