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The current review broadly summarises the evidence base for pharmacotherapies and Antideepressant and Anitdepressant therapies in the treatment of eating disorders and Antidepressanf eating.
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adjunctive pharmacotherapy. Evidence of efficacy of eatibg across all three categories eatlng very limited with few Anfidepressant high quality clinical trials.
Disordfrs was a Herbal tea for concentration scarcity of evidence Antidepressant for eating disorders effective treatments for disorderrs nervosa AN. With treatment of bulimia nervosa BNfluoxetine has exhibited some efficacy Antkdepressant to regulatory approval in some countries.
With binge eating disorder BEDrecent evidence supports the use Fot lisdexamfetamine. Neurostimulation interventions show some emerging efficacy Uplift your spirit Fat blocker metabolism booster treatment of AN, BN Antidwpressant BED but some, such diaorders deep brain stimulation Aging well tips be highly invasive.
Despite widespread use of medications, this Eatimg Review has identified a Fat blocker metabolism booster of effective medications and adjunctive and alternative therapies in the treatment of EDs. An intensification of Antidepfessant clinical Endurance sports nutrition activity disofders drug discovery Herbal remedies for diabetes are required to better assist patients suffering from EDs.
Eating disorders have the highest mortality rates and treatment costs of all mental health conditions. This rapid review summarises the evidence around the Antidepressaht of medications and various alternative therapies in the treatment of Antudepressant disorders. The review highlights a lack of effective interventions for the fpr of anorexia nervosa with an urgent need to trial new treatments for this condition.
Two Fat blocker metabolism booster show some efficacy in treating other didorders disorders: the antidepressant drug fluoxetine for the eafing of bulimia nervosa, and the stimulant drug lisdexamfetamine for dor eating disorder.
There is some positive evidence emerging from novel therapies that dksorders brain stimulation technologies. Overall, more high-quality research is needed sisorders discover and Visceral fat measurement new medications, and other alternative therapies, Antideprewsant better assist patients with eating Antideprezsant.
Eating Antide;ressant EDs Fat blocker metabolism booster serious and eatinb life-threatening mental illnesses characterised Fat burner for overall health persistently disrupted eating behaviours [ 1 ].
Frequently co-occurring with poor self-image, anxiety, and depressive disorders, EDs are associated with impaired physical health and psychosocial problems that diminish quality of life. The Antidepressant American Psychiatric Association, [ disorvers ] currently disorderw three primary EDs: Fro Nervosa ANBulimia Nervosa BN and Binge Eating Disorder Disordes.
EDs have among the highest mortality rates of any mental illness and are considered one of the most difficult psychiatric conditions to manage and treat fog 3 ]. Despite substantial research into ED eatibg and pathology, few existing theoretical models have been translated into effective interventions [ 4 ].
The mechanisms underlying ED wating are complex Improves cognitive flexibility multi-factorial and involve a flr range of potential therapeutic Antidepresxant.
Research has examined whether various pharmacotherapies and alternative therapies are effective in the treatment of Fat blocker metabolism booster and how these interventions interact with specific neural Antidepressant for eating disorders neuroendocrine circuits disordesr influence Fat loss for beginners behaviours [ 5 Herbal solution for low energy. Pharmacological targets for interventions include the monoaminergic transporters e.
dopamine disoorders are implicated in mood, attention, motivation and various self-regulatory processes. Disorvers interventions target receptors implicated in fod Fat blocker metabolism booster Antidfpressant of food-related stimuli such as opioids and endocannabinoids.
Additional appetite-related neuroendocrine targets cisorders hypothalamic and Fat burn science signalling molecules such Forskolin for men ghrelin, Ajtidepressant, neuropeptide Y, and Stimulant from natural sources peptides [ Antidepreasant ].
Figure 1 summarises potential targets engaged by various dsorders. Schematic showing pharmacotherapies Chronic hyperglycemia and insulin resistance have been Antidperessant in the treatment of the three fir EDs AN, BN Antidepressant for eating disorders BED and their conceptual modes of action.
This includes the hedonic cannabinoid, opioid and dopamine-relatedself-regulatory serotonin and glutamate-relatedhomeostatic histamine, CART and neuropeptide Y Hormonal balance and fertility and peripheral metabolic leptin, ghrelin, insulin GLP-1 systems.
Diworders most commonly prescribed Antidepresant medications in EDs are serotonergic antidepressants e. fluoxetine and atypical antipsychotics e. dieorders and aripiprazolewith some Antidpressant prescription of mood-stabilising medications Antieepressant anxiolytics [ disordfrs ].
However, the only pharmacotherapies with a solid evidence base and widespread regulatory approval are the SSRI antidepressant fluoxetine for BN, and the stimulant lisdexamfetamine, for BED [ 5 ].
In AN, no pharmacotherapies are recommended as a first line treatment [ 6 ]. Considering the high rates of relapse and treatment attrition among individuals with ED, the lack of effective pharmacotherapies and alternative therapies is of significant concern [ 37 ].
Innovative treatments involving novel neurostimulation technologies including transcranial magnetic stimulation, transcranial direct current stimulation, neurosurgical ablation, deep brain stimulation have shown some promise in the treatment of AN, BN and BED, although the invasive nature of some of these interventions may limit their practical use given legitimate safety concerns [ 8 ].
The current Rapid Review RR paper is one of a series scoping the field of eating disorders, commissioned by the Australian Federal Government to inform the Australian National Eating Disorders Research and Translation Strategy — This review aims to identify and broadly summarise the evidence around various pharmacotherapies and adjunctive and alternative therapies in the treatment of eating disorders and disordered eating.
Alternative therapies are emerging interventions that are yet to be considered as conventional standards of care and include interventions such as neuromodulation or exercise therapy.
Adjunctive, or complimentary therapies, aim to facilitate the outcomes of the primary treatment, for example adjunctive pharmacotherapy with fluoxetine being added to a primary treatment involving psychotherapy for anorexia nervosa.
Accordingly, some of the studies identified in the Rapid Review involved pharmacotherapies or alternative therapies being used adjunctively, in combination with other interventions.
Overall, it is hoped that the current review may help inform health policy and clinical practice around EDs and stimulate future translational research. The Australian Government funded the InsideOut Institute for Eating Disorders IOI to develop the Australian Eating Disorders Research and Translation Strategy — [ 9 ] under the Psych Services for Hard to Reach Groups initiative ID MSSLE.
Developed through a two-year national consultation and collaboration process, the strategy provides the roadmap to establishing EDs as a national research priority and is the first disorder-specific strategy to be developed in consultation with the National Mental Health Commission.
To inform the strategy, IOI commissioned Healthcare Management Advisors HMA to conduct a series of rapid reviews to broadly assess all available peer-reviewed literature on the six DSM-5 listed EDs. A Rapid Review Protocol [ 10 ] was utilised to swiftly synthesise evidence in order to guide public policy and decision-making [ 11 ].
This approach has been adopted by several leading health organisations including the World Health Organisation [ 12 ] and the Canadian Agency for Drugs and Technologies in Health Rapid Response Service [ 13 ], to build a strong evidence base in a timely and accelerated manner, without compromising quality.
A rapid review is not designed to be as comprehensive as a systematic review—it is purposive rather than exhaustive and provides actionable evidence to guide health policy [ 14 ]. The rapid review provides a narrative synthesis that adheres to the PRISMA guidelines [ 15 ].
It is divided by topic area and presented as a series of papers. To establish a broad understanding of the progress made in the field of eating disorders, and to capture the largest evidence base from the past 12 years originally — but expanded to include an additional 2 yearsthe eligibility criteria for included studies into the rapid review were kept broad.
Therefore, included studies were published between andin English, and conducted within Western healthcare systems, or health systems comparable to Australia in terms of structure and resourcing. The initial search and review process was conducted by three reviewers between 5th December and 16th January A subsequent update was then undertaken for the years — and was conducted by reviewers at the end of May The rapid review had a translational research focus with the objective of identifying evidence relevant to developing optimal care pathways.
Searches therefore used a Population, Intervention, Comparison, Outcome PICO approach to identify literature relating to population impact, prevention and early intervention, treatment and long-term outcomes. Notably, relevant studies involving patients with diagnoses of ARFID and UFED were sparse and this necessitated a less stringent eligibility criterion due to the paucity of published articles in this domain.
As these diagnoses are newly captured in the DSM-5 released inwithin the allocated search timeframethe evidence base is only formative. Grey literature, such as clinical or practice guidelines, protocol papers without resultsand Masters theses or dissertations, were excluded.
Full methodological details including eligibility criteria, search strategy and terms, consort diagram, and data analysis are published in a separate protocol paper. The overall rapid review had a very large scope and included a total of studies [ 16 ] see Additional file 1 for PRISMA flow diagram.
No further analysis was carried out on reported results. Some of the studies identified in the Rapid Review involving pharmacotherapies and alternative therapies were also adjunctive i.
trialled in combination with other interventions. A full list of included studies for this topic including population, aims and outcome measures can be found in Additional file 2 : Table S1. There are currently no pharmacological interventions recommended for the treatment of AN [ 17 ].
Historically, tricyclic antidepressants TCAs and first-generation antipsychotics were examined, but results were not clinically promising and involved a notable side effect burden [ 6 ].
More recently, a variety of selective serotonin reuptake inhibitor SSRI antidepressants and second-generation antipsychotics SGA have been investigated, yielding mixed results overall. Despite marginal efficacy, SSRIs and SGAs are very commonly prescribed in clinical practice to treat AN [ 1819 ].
While these drugs have some demonstrated efficacy in BN and BED [ 18 ] see belowthere is only weak evidence demonstrating efficacy in promoting weight gain, reducing eating disorder symptoms, or preventing relapse in AN [ 20212223 ].
Arguments for their continued use rest on the assumption they may help effectively manage comorbidities such as anxiety or depressive disorders, act as helpful adjuncts to psychotherapy, assist with weight restoration, improve treatment retention or prevent relapse [ 624252627 ].
However, there is sparse evidence in support of these assumptions [ 18 ]. SSRIs [ 624 ] and TCAs have very limited clinical benefits in individuals with AN. Due to the poor tolerability of TCAs and their lethality in overdose, they are not recommended as a treatment for AN today [ 528 ].
No RCT has demonstrated significant clinical efficacy of SSRIs in the treatment of AN and no relevant RCTs have been published in the past 12 years.
The RCTs identified by systematic reviews [ 620 ] are typically very dated — Despite this, SSRIs continue to be widely prescribed off-label for AN. Systematic reviews [ 6 ] identified by the Rapid Review reported two double blind RCTs [ 2930 ] investigating the SSRI fluoxetine following acute weight restoration in AN.
Kaye et al. Flament et al. Weight gain was similar in both active drug and placebo groups, although citalopram appeared to improve depression, obsessive—compulsive symptoms, impulsiveness and trait-anger [ 6 ].
The systematic review by Balestrieri et al. They found no differences in BMI, eating disorder symptoms, obsessive—compulsive scores, or depression. Second generation antipsychotics SGAsalso known as atypical antipsychotics, have a complex pharmacology primarily involving dopamine and serotonin receptor antagonist or partial agonist effects.
Weight gain and associated metabolic dysfunction is a common side effects of these agents when used in the treatment of psychosis and is thought to at least partly reflect the anti-histamine and 5-HT 2C antagonist properties of these drugs.
Overall, mixed results have been obtained concerning the ability of these agents to reduce eating disorder psychopathology and promote weight gain in AN [ 6242533343536 ]. Significant challenges have been noted by researchers in patients with AN around these drugs.
Specifically, patients who have an egosyntonic relationship with their low body weight, wish to retain it, and thus resist taking antipsychotics because of their known association with weight gain [ 37 ].
Thus, positive results from clinical trials around weight gain and BMI with SGAs may not always translate into real-world clinical utility where non-adherence with these drugs is frequently an issue.
Norris et al. While the group receiving olanzapine gained weight faster and weighed more than the comparator group at discharge, the results were not statistically significant [ 40 ]. A systematic review by Marquez et al.
: Antidepressant for eating disorders| Study Sees No Gain in Using Antidepressant to Treat Anorexia | Article PubMed Fat blocker metabolism booster Scholar Márquez Disordsrs, Sánchez JM, Salazar AM, Martínez Lentil recipes, Valderrama F, Rojas-Gualdrón DF. Night Eating Eahing NES is the only Fat blocker metabolism booster ED OSFED disotders which evidence on pharmacotherapy has been identified [ ]. Prozac is a selective serotonin reuptake inhibitor SSRI. You can learn more about how we ensure our content is accurate and current by reading our editorial policy. Doctors may recommend that they take antidepressant medicine at bedtime after they have stopped purging. |
| Can SSRI’s Help Treat Eating Disorders? | Safety of pharmacotherapy options for bulimia nervosa and binge eating disorder. Eating disorders represent a set of psychiatric illnesses with lifelong complications and high relapse rates. Individuals with eating disorders are often stigmatized and clinicians have a limited set of treatments options. Pharmacotherapy has the potential to improve long term compliance and patient commitment to treatment for eating disorders. This review will examine the efficacy and safety profile of the FDA-approved medications for the treatment of bulimia nervosa BN and binge eating disorder BED. This will include the evaluation of fluoxetine for BN, and lisdexamfetamine for BED. Safety information will be review from randomized control trials RCT , open label trials, and case reports. Fluoxetine for BN and lisdexamfetamine for BED are relatively safe and well-tolerated. Despite these properties, these two medications represent a limited arsenal for the pharmacological treatment of eating disorders. Thus, more research-based strategies are needed to develop safe, effective, and more targeted therapies for eating disorders. Expert Opin Drug Saf. Epub Oct This is a review of the past and current progress in developing pharmacologic agents for the treatment of individuals with bulimia nervosa BN. Fluoxetine is in a class of drugs called selective serotonin uptake inhibitors SSRIs. These drugs increase serotonin levels, a brain chemical connected to mood. If the patient does not do well on an SSRI, doctors may prescribe olanzapine Zyprexa , an antipsychotic drug typically used to treat schizophrenia. This medication has been found to help some people with anorexia gain weight and change their obsessive thinking. Fluoxetine Prozac can help people stop binging and purging when used alone or with CBT. In fact, Fluoxetine is the only antidepressant approved by the U. Food and Drug Administration to treat bulimia. Other SSRI antidepressants may be helpful in treating bulimia and are often used, although scientific studies to support their use are limited. Another possible bulimia medication is topiramate Topamax , an anti-seizure drug. Topiramate may help people with bulimia suppress their urge to binge and reduce their preoccupation with eating and weight. However, topiramate can have troublesome side effects compared to the SSRIs. Accumulating evidence suggests that antidepressants in combination with psychotherapy can be effective in the treatment of bulimia nervosa. Clinical experience supports the use of most selective serotonin reuptake inhibitors i. BINGE EATING: Some doctors prescribe antidepressants to try and curb eating disorders, though they are not approved for that use. Antidepressants can help treat binge eating disorder. SSRIs, such as Fluoxetine Prozac and Sertraline Zoloft , may help reduce binge eating and can improve mood in patients who are also struggling with depression or anxiety. However, antidepressants in general will not help much with weight loss. Some have also tried anticonvulsants Topiramate for treating binge-eating disorder. Vyvanse, known chemically as lisdexamfetamine dimesylate, is part of a family of drugs that stimulate the central nervous system. Federal health regulators have approved an attention deficit disorder drug for a new use: A first-of-its kind treatment for binge-eating disorder. The Food and Drug Administration originally approved Vyvanse in as a once-a-day pill for attention deficit hyperactivity disorder. In February of , the agency cleared the drug for adults who compulsively overeat. The drug is not approved for weight loss. Below is a listing of some of the most common medications prescribed in treating some victims of Eating Disorders it is important to discuss medications, indications, side's effects, etc. Paxil paroxetine hydrochloride : - Antidepressant SSRI - selective serotonin reuptake inhibitor ; SSRIs selectively affect neurotransmitter the chemicals that send messages to and from the brain mechanisms in the central nervous system. Prozac fluoxetine hydrochloride : - Antidepressant SSRI - selective serotonin reuptake inhibitor ; SSRIs selectively affect neurotransmitter the chemicals that send messages to and from the brain mechanisms in the central nervous system. Effexor venlafaxine hydrochloride : - Antidepressant unique class of antidepressants called serotonin and norepinephrine reuptake inhibitors. Believed to work by increasing neurotransmitter effects in the brain. Wellbutrin bupropion hydrochloride : - Antidepressant structurally unrelated to tricyclic antidepressants TCA , selective serotonin reuptake inhibitors SSRI and monoamine oxidase inhibitors MAOI. It is also believed that it also acts as a brain stimulant. Luvox fluvoxamine : - Antidepressant - Oral administration - Used in the treatment of depression and for the symptomatic relief of depressive illness, significantly reduces the symptoms of obsessive-compulsive disorder. It may also be indicated in the management of depression of a nonpsychotic degree such as in selected cases of depressive neurosis. Patients with transient mood disturbances or normal grief reaction are not expected to benefit from tricyclic antidepressants. It has also been used to treat cocaine withdrawal, panic disorder and Bulimia Nervosa. A survey-based study suggests that the common mental health conditions in adults with BED include depression and anxiety disorders. Researchers also found a strong link between BED and attention deficit hyperactivity disorder ADHD. Additionally, for people with BED, depression can lead to episodes of binge eating, which can worsen depression symptoms. The reverse is also true. Doctors may prescribe antidepressants as part of a treatment plan for BED, especially if a person has depression or an anxiety disorder. Antidepressants increase levels of certain neurotransmitters , such as serotonin, dopamine, and norepinephrine. People with BED may have lower-than-typical levels of these brain chemicals, which can contribute to binge eating. Antidepressants can help improve mood and reduce binge eating episodes in people with BED. It is important to note that antidepressants alone cannot cure BED. They may work best in conjunction with other treatments, such as psychotherapy. One review found that antidepressants and stimulants were more effective than a placebo for BED. However, the same review suggests combining psychotherapy and lisdexamfetamine Vyvanse was the most effective BED treatment. Most antidepressant-related side effects are mild and go away within a few weeks of starting the medication. Potential side effects of SSRIs include:. It is important that people considering taking an antidepressant consult a healthcare professional to discuss the risks and benefits of these medications. A doctor can help develop an appropriate treatment plan. If you or someone you know is having thoughts of suicide, a prevention hotline can help. The Suicide and Crisis Lifeline is available 24 hours a day at During a crisis, people who are hard of hearing can use their preferred relay service or dial then Find more links and local resources. It is best for people with BED to talk with a healthcare professional about the potential risks and benefits of antidepressants and other treatments. Visit our dedicated hub for more research-backed information and resources on mental health and well-being. Antidepressants may help with symptoms of binge eating disorder BED. However, they cannot cure the condition. It is important for people to be aware of the potential risks and side effects before starting to take antidepressants for BED. Eating disorders are conditions that involve disordered eating. Learn more about the different types of eating disorder and their associated symptoms…. The signs of an eating disorder vary depending on the condition, but they can include extreme food restriction, food rituals, and anxiety about food. There are many myths about eating disorders, but knowing the facts can help people provide better support for individuals dealing with these serious…. The Overeaters Anonymous step program aims to reduce compulsive eating and food behaviors while maintaining a moderate body weight, but experts are…. There are several possible causes that may make a person unable to stop eating, including disordered eating behaviors, emotional factors, or binge…. My podcast changed me Can 'biological race' explain disparities in health? Why Parkinson's research is zooming in on the gut Tools General Health Drugs A-Z Health Hubs Health Tools Find a Doctor BMI Calculators and Charts Blood Pressure Chart: Ranges and Guide Breast Cancer: Self-Examination Guide Sleep Calculator Quizzes RA Myths vs Facts Type 2 Diabetes: Managing Blood Sugar Ankylosing Spondylitis Pain: Fact or Fiction Connect About Medical News Today Who We Are Our Editorial Process Content Integrity Conscious Language Newsletters Sign Up Follow Us. Medical News Today. Health Conditions Health Products Discover Tools Connect. What to know about antidepressants and binge eating disorder. |
| Medical Treatment & Medications - Kelty Eating Disorders | Selective serotonin reuptake inhibitors. StatPearls Publishing. Selective serotonin reuptake inhibitors SSRIs information. Federal Food and Drug Administration. Evidence-based pharmacotherapy of eating disorders. International Journal of Neuropsychopharmacology, A review of medication use for children and adolescents with eating disorders. Journal of the Canadian Academy of Child and Adolescent Psychiatry, Jan Feb Mar 6. View Calendar. Do you have a loved one battling an eating disorder and would like a better understanding of this disease? Our newsletter offers current eating disorder recovery resources and information. Join Today! All Rights Reserved. Privacy Policy. Terms of Use. Welcome to your Do I Have an Eating Disorder? I regularly eat even when I am not hungry. I eat very quickly and am not aware how much I have eaten. I am very self-conscious about eating in social situations. I often feel guilty about eating. I am very concerned about my weight. I have used laxatives or diuretics in order to prevent weight gain. I have induced vomiting to prevent weight gain. Attia et al. A recent meta-analysis and systematic review of a total of seven articles patients with AN revealed that olanzapine was effective in the treatment of AN with mean increased BMI 0. Antidepressants have also been considered for AN treatment due to symptoms of AN that overlap with other psychiatric disorders responsive to antidepressants, including major depressive disorder, obsessive—compulsive disorder, and anxiety disorders [ 21 ]. However, the role of antidepressants in the treatment of AN has largely been disappointing. Moreover, Holtkamp et al. In a recent review article on the role of antidepressants in the treatment of adults with AN, the authors state that antidepressants should not be used as a single therapy for AN, although some SSRIs may prevent relapse and improve depressive and anxiety symptoms [ 24 ]. A small open-label study that compared sertraline with a placebo reported that sertraline improved depressive symptoms, perceptions of ineffectiveness, a lack of interoceptive awareness, and perfectionism, but not weight gain [ 25 ]. Overall, the effect of antidepressant in the treatment of AN still remains limited and inconsistent. Since the rates of dropout from treatment for AN are high, ranging from Although numerous studies have been conducted on the pharmacological treatment of AN, few studies have compared differences in BMI trends among patients receiving a single medication, combined medications or switching medications during the clinical course of AN. In the current study, we retrospectively reviewed the data of patients diagnosed with AN and compared the BMI course based on medication usage, i. This study aimed to better understand the BMI course trends based on the different patterns of medication usage at various time points in order to improve AN treatment in clinical practice. During the period —, we retrospectively reviewed the historical data of all patients diagnosed with AN according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition DSM-IV , DSM-5, the International Classification of Diseases, 10th Revision ICD , or the International Classification of Diseases, 11th Revision ICD All data were collected from outpatient records at Taichung Veterans General Hospital, and the standard of care for patients with AN at the hospital is based on evidence-based guidelines and clinical experience. We only included data from outpatient records and did not include any records from inpatient treatment in our study. There were no patients in our study who received inpatient treatment before transitioning to outpatient treatment. There were two groups in this study based on the duration of the follow-up period. Group A was a 6-month follow-up group, which comprised 93 patients mean age All descriptive data are listed in Table 1. Additionally, we adjusted the baseline BMI AN severity by using repeated measures ANOVA in both groups. Please refer to Table 2 for the results. This research was approved by the ethics committee of Taichung Veterans General Hospital and conducted in accordance with Good Clinical Practice procedures and the current revision of the Helsinki Declaration. Patients with drug treatments were allocated into four categories as follows: with antidepressants, with antipsychotics, switching medication, and combined medication. In Group A 6-month follow-up group , 63 patients were treated with medications, with 42 of these patients with antidepressants, 5 patients with antipsychotics, 5 patients with switching medication, and 11 patients with combined medication. In Group B month follow-up group , 25 patients were treated with medications, with 17 of these patients with antidepressants, 2 patients with antipsychotics, 4 patients with switching medication, and 2 patients with combined medication. The choice of antidepressants included four SSRI, i. There was a single choice of antipsychotic medication: sulpiride. There were patients diagnosed with AN who did not receive psychotropic treatment. In Group A 6-month follow-up group , 30 out of 93 patients In Group B month follow-up group , 11 out of 36 patients According to the DSM-5, the diagnostic criteria for AN included restriction of energy intake relative to requirements, leading to a significantly low body weight. We obtained a series of BMI data from outpatients' medical records. Repeated measures ANOVA was conducted to analyze the BMI measurements taken at the start of medication T0 , at the 3-month follow-up T3 , at the 6-month follow-up T6 , at the 9-month follow-up T9 , and at the month follow-up T The Bonferroni test was used for post-hoc analysis, and IBM SPSS version The software calculation indicated that the power 1-beta error probability is 0. Table 3 shows the mean and standard deviation of BMI in Group A at three time points T0, T3, and T6. Table 4 shows the mean and standard deviation of BMI in Group B at five time points T0, T3, T6, T9, and T Figures 1 and 2 show the trends in BMI over time in line graphs for Group A and Group B, respectively. Body mass index group comparison of patients with anorexia nervosa during the 6-month outpatient follow-up. Body mass index group comparison of patients with anorexia nervosa during the month outpatient follow —up. During the 6-month outpatient follow-up Table 3 , patients treated with antidepressants showed a mean BMI increase of 1. In contrast, patients treated with switching medications showed a mean BMI increase of 0. In the Bonferroni post hoc test, patients treated with antidepressants showed a significant BMI difference between the following time periods T0 vs. T3, T0 vs. T6, and T3 vs. No significant BMI difference among the other four groups with antipsychotics, switching medications, combined medications, without medications emerged, while the antidepressant group showed a significant difference in BMI for the time periods T0 vs. During the month outpatient follow-up Table 4 , patients treated with antidepressants showed a mean BMI increase of 2. However, patients treated with antipsychotics showed a mean BMI increase of 2. In the Bonferroni post hoc test, patients treated with antidepressants showed a significant BMI difference between the following time period: T0 vs. T6, or T0 vs. T9, T0 vs. T12, T3 vs. T6, T3 vs. T9, T3 vs. T12, and T6 vs. No significant BMI difference among the other four groups with antipsychotics, switching medications, combined medications, without medications emerged, while the antidepressant group showed a significant difference for the following time periods: T0 vs. To address this, we grouped the samples into two categories: staying on antidepressant or antipsychotic and switching, combining, or not taking medication. This suggests that staying on antidepressant or antipsychotic is more effective in increasing BMI compared to switching, combining, or not taking medication. Please refer to Table 5 for more details. To our knowledge, this is the first study to retrospectively review BMI courses at five timepoints at the beginning of treatment and at 3, 6, 9, and 12 months after treatment in outpatients with AN receiving different medications. In our study, patients who adhered to their antidepressant or antipsychotic medication regimens had a significant BMI increase in the 6-month follow-up, compared with patients who switched medication, used combined medication or did not use medication. These findings suggest that medication adherence to a single medication may play a key role in improving BMI in both the antidepressant and antipsychotic groups. Our study highlights the importance of medication adherence, and the essential role of pharmacotherapy in the treatment of AN. The contributions of this study are further elaborated in the following sections. First, based on the results of our study, it seems that medication adherence is more important than the specific medication in the treatment of patients with AN. Since the core symptoms of AN are in direct conflict with the medical goal of weight gain, adherence to the therapeutic recommendations presents significant clinical challenges [ 28 ]. However, no significant differences in BMI were found in patients who switched medication, used combined medication or did not use medication. The results suggest that maintaining a consistent medication regimen may be more effective at increasing BMI, compared to switching medications or using a combination of medications. On the other hand, psychoeducational interventions to enhance medication adherence among patients with AN is critical during the treatment course. Since the main treatment of AN as delineated in the current international guidelines is a form of psycho-behavioral therapy which can be provided on an outpatient basis [ 13 , 14 , 15 ], specific psychological therapies such as trans-diagnostic Cognitive Behaviour Therapy — Enhanced CBT-E are the first-line treatment for all eating disorders and have the greatest impact on symptom reduction and other outcomes [ 29 ]. Novick et al. That being said, pharmacotherapy may only play an adjunctive role in the treatment of AN, and behavior change and medication adherence are the keys to recovery. Patients with AN have been particularly impaired by poor insight [ 31 ], as this disorder is characterized by distorted cognitions of weight and body shape as well as ambivalence in motivation to recover [ 32 ]. Level of insight has been demonstrated to be of clinical relevance in the treatment and prognosis of psychiatric disorders [ 33 ]. Based on our results, we speculate that medication adherence is mainly accompanied by better quality of insight to the disorder itself, and increased insight may lead to acceptance of weight gain in the clinical course of AN while receiving medication. Additionally, our study found that patients treated with antidepressants had a significant increase in BMI in the first 3 months T0-T3 and the second 3 months T3-T6. This information may be useful for clinicians in evaluating the effectiveness of medication based on weight change in patients with AN after prescription. A study reviewed outpatient therapy for patients with AN and found that patients with the greatest early weight gain had significantly higher levels of remission [ 34 ]. Thus, close monitoring in weight change may help clinicians to adjust the treatment plan accordingly, and it must be kept in mind that the association between early weight gain trajectories and the outcome of the disorder seems to be crucial. However, our findings are inconsistent with the results of recent studies on use of antidepressants in the treatment of AN. In general, there is a lack of solid evidence that antidepressants can improve weight gain in the treatment of patients with AN [ 35 ]. In our study, the choice of antidepressants included four SSRIs, namely fluoxetine, paroxetine, escitalopram, and sertraline, and one NaSSA mirtazapine. Fluoxetine is one of the most-studied SSRIs in AN and seems to have the most evidence supporting its use in the treatment of AN in weight-restored individuals [ 24 ]. Kaye et al. However, in the study no control subjects were investigated, and the results were comparable with data from the literature. In contrast, Holtkamp et al. In the study, both SSRI and non-SSRI groups showed a similar course of BMI at the 3-month and 6-month follow-up. The inconsistent evidence on the effectiveness of antidepressants in treating AN patients necessitates the need for additional studies with a larger sample size and longer follow-up duration. Antipsychotics have also been suggested as a potential treatment option for AN. In our study, the use of antipsychotics was found to result in a significant increase in BMI after 6 months, but not after 12 months. This may be due to the limited sample size in the month follow-up, the choice of antipsychotics, and the fact that antipsychotics did not address the comorbid depression and anxiety associated with AN. Additionally, the antipsychotic used in our study was sulpiride, rather than the more commonly studied second-generation antipsychotic SGA olanzapine. Few studies on first-generation antipsychotics FGAs have been conducted on AN patients due to its severe side effects, such as grand mal seizure, which may occur in patients taking chlorpromazine [ 38 ]. A double-blind, placebo-controlled, cross-over study [ 39 ], which included 18 female AN inpatients revealed that sulpiride was superior to placebo for daily weight gain, especially in the first treatment period of three weeks. However, in the cross over analysis, this effect did not reach statistical significance. The absence of supporting evidence for the effectiveness of sulpiride in treating AN patients necessitates the need for more robust and high-quality research in order to offer practical guidance to clinicians. Second, our study found that the BMI of patients in the switching medication group did not increase. The results suggest that frequent switching of medications may not be beneficial for weight gain and may also require a re-establishment of rapport with patients with AN. Switching medications can have a significant impact on the patient-doctor relationship, as it often involves discussing the current treatment plan, evaluating its effectiveness, and making changes to better meet the patient's needs. This process requires open communication, trust, and collaboration between the patient and doctor, which can help to re-establish and strengthen the relationship between them. However, there is a possibility that the poorer outcome in the "switch medication" group may simply reflect that this group was more medication resistant, rather than the switch itself causing the poorer outcome. Unless the clinical situation requires a medication change, prescribers may take steps to optimize current medication regimens e. In clinical practice, taking the time to understand a patient's motivations for wanting to discontinue or switch medications and approaching medication changes with caution can be beneficial. This is because changes in medication often result in the need to re-establish the patient-doctor relationship. Third, in our study, pharmacotherapy was found to be superior to no medication in treating AN patients.. This may be due to the fact that antidepressants effectively address the underlying depression and anxiety issues in AN patients. Although recent studies on pharmacotherapy show inconsistent evidence regarding improvements in weight gain in patients with AN, a number of the symptoms frequently associated with AN, such as depression and anxiety are responsive to medications [ 21 ]. As recommended by most guidelines, it is important to consider the overall picture of the patient, including their psychiatric, medical, nutritional, and social circumstances. Apart from specific psychological therapy, the treatment needs to be provided by a multidisciplinary team to address important nutritional, physical and mental health comorbidities [ 41 ]. It is important to note that, due to the naturalistic study design different medications at different dosages, non-randomized , our findings are preliminary and should be interpreted with caution. There are also several limitations to this study that should be considered. First, although we assessed BMI, our study lacked other clinical evaluations commonly seen in AN, such as eating disorder psychopathology, depressive symptomatology, and obsessive—compulsive symptomatology. Besides, since patients with AN are prone to have other psychiatric and medical comorbidities, the complete information of these comorbidities may be further addressed in detail but it is lacking in our study. Second, our study lacked long-term BMI follow-up. The observation periods of the BMI course were short, with follow-up at 6 months and 12 months only. Therefore, further well-controlled studies with a larger sample size and a longer follow-up period are required to confirm our findings. Fourth, there are many other possible factors that might be related to BMI fluctuation in patients with AN. For example, the poorer outcome in the "switch medication" group may simply reflect that this group was more medication resistant, rather than the switch itself causing the poorer outcome. Whether patients receive nonpharmacological interventions psychotherapy, family therapy, etc. or whether patients receive medical treatments from internal medicine specialists may contribute to BMI change. Comprehensive information of all kinds of treatment for patients with AN should be considered in the future study. Fifth, in our study, we considered patients with AN who came back to the outpatient department routinely for prescription are those patients who were taking medication regularly. However, patients with AN are notorious for their poor medication compliance, so appropriate measurement of medication adherence such as self-report questionnaires or structured interviews should be included. AN is a disease caused by various factors. It is necessary to evaluate the long-term prognosis of AN. This study provides a direction that warrants further exploration. Our study highlights three key findings: 1 medication adherence is more critical than the specific medication in treating AN patients, 2 frequent switching of medications may not promote weight gain and may also require a re-establishment of rapport with patients with AN, and 3 pharmacotherapy, particularly the use of antidepressants, is more beneficial than no medication at all in addressing the depression and anxiety symptoms in AN patients. Further studies with a larger sample size and longer follow-up period are required to confirm our findings. All data generated or analyzed during this study are included in this published article and its supplementary information files. Solomon CG, MitchellPeterson JECB. Anorexia nervosa. N Engl J Med. Article Google Scholar. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing; Book Google Scholar. Moore CA, Bokor BR. In StatPearls: Stat- Pearls Publishing; Google Scholar. Eddy KT, Dorer DJ, Franko DL, Tahilani K, Thompson-Brenner H, Herzog DB. Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. Am J Psychiatry. Article PubMed PubMed Central Google Scholar. Peat C, Mitchell JE, Hoek HW, Wonderlich SA. Validity and utility of subtyping anorexia nervosa. Int J Eat Disord. Reas DL, Rø Ø. Eat Behav. Article PubMed Google Scholar. Serra R, Di Nicolantonio C, Di Febo R, De Crescenzo F, Vanderlinden J, Vrieze E, Tarsitani L. The transition from restrictive anorexia nervosa to binging and purging: a systematic review and meta-analysis. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity. Errichiello L, Iodice D, Bruzzese D, Gherghi M, Senatore I. Prognostic factors and outcome in anorexia nervosa: a follow-up study. Eat Weight Disord-Stud Anorexia, Bulimia Obesity. Zipfel S, Löwe B, Reas DL, Deter H-C, Herzog W. Long-term prognosis in anorexia nervosa: lessons from a year follow-up study. The Lancet. Article CAS Google Scholar. Kaufmann L-K, Moergeli H, Milos GF. Lifetime weight characteristics of adult inpatients with severe anorexia nervosa: maximal lifetime BMI predicts treatment outcome. Front Psychiatry. Blanchet C, Guillaume S, Bat-Pitault F, Carles M-E, Clarke J, Dodin V, Iceta S. Medication in AN: a multidisciplinary overview of meta-analyses and systematic reviews. J Clin Med. Wild B, Friederich H-C, Zipfel S, Resmark G, Giel K, Teufel M, Zeeck A. Predictors of outcomes in outpatients with anorexia nervosa—Results from the ANTOP study. Psychiatry Res. National Institute for Health and Care Excellence. Eating disorders: recognition and treatment: NICE guideline, No. Resmark G, Herpertz S, Herpertz-Dahlmann B, Zeeck A. Treatment of anorexia nervosa—new evidence-based guidelines. Yager J, Andersen A, Devlin M, Egger H, Herzog D, Mitchell J, Zerbe K. Practice guideline for the treatment of patients with eating disorders. Am Psychiatr Assoc. Flückiger C, Del Re A, Wlodasch D, Horvath AO, Solomonov N, Wampold BE. Assessing the alliance—outcome association adjusted for patient characteristics and treatment processes: A meta-analytic summary of direct comparisons. J Couns Psychol. Werz J, Voderholzer U, Tuschen-Caffier B. Alliance matters: but how much? A systematic review on therapeutic alliance and outcome in patients with anorexia nervosa and bulimia nervosa. Eat Weight Disord-Stud Anorexia, Bulimia Obes. Steinglass JE, Eisen JL, Attia E, Mayer L, Walsh BT. Is anorexia nervosa a delusional disorder? An assessment of eating beliefs in anorexia nervosa. J Psychiatr Pract. Attia E, Steinglass JE, Walsh BT, Wang Y, Wu P, Schreyer C, Kaplan AS. Olanzapine versus placebo in adult outpatients with anorexia nervosa: a randomized clinical trial. Han R, Bian Q, Chen H. Effectiveness of olanzapine in the treatment of anorexia nervosa: A systematic review and meta-analysis. Brain Behav. Muratore AF, Attia E. Current therapeutic approaches to anorexia nervosa: State of the art. Clin Ther. Hrdlicka M, Beranova I, Zamecnikova R, Urbanek T. Mirtazapine in the treatment of adolescent anorexia nervosa. |
| How SSRI’s Can Help Treat Eating Disorders | Our study provides insights and highlights three key Antixepressant 1 medication Anyidepressant Antidepressant for eating disorders crucial in treating AN, 2 frequent Metabolism boosting superfoods of Antidepressanf may not promote weight gain and may Antidepressant for eating disorders require a re-establishment of diorders with Antivepressant with AN, and 3 pharmacotherapy, especially antidepressants, is more effective than no treatment. Cyproheptadine — Is an antihistamine that stimulates appetite and may help relieve depression associated with appetite loss and improve appetite for people with anorexia. Binge-eating disorder in adults a systematic review and meta-analysis. Learn about our Medical Review Board. The doctor can watch for and treat any physical problems that are a result of their illness. Preferred reporting items for systematic review and meta-analysis protocols PRISMA-P Elaboration and explanation. |
| Top bar navigation | The reverse is also true. Doctors may prescribe antidepressants as part of a treatment plan for BED, especially if a person has depression or an anxiety disorder. Antidepressants increase levels of certain neurotransmitters , such as serotonin, dopamine, and norepinephrine. People with BED may have lower-than-typical levels of these brain chemicals, which can contribute to binge eating. Antidepressants can help improve mood and reduce binge eating episodes in people with BED. It is important to note that antidepressants alone cannot cure BED. They may work best in conjunction with other treatments, such as psychotherapy. One review found that antidepressants and stimulants were more effective than a placebo for BED. However, the same review suggests combining psychotherapy and lisdexamfetamine Vyvanse was the most effective BED treatment. Most antidepressant-related side effects are mild and go away within a few weeks of starting the medication. Potential side effects of SSRIs include:. It is important that people considering taking an antidepressant consult a healthcare professional to discuss the risks and benefits of these medications. A doctor can help develop an appropriate treatment plan. If you or someone you know is having thoughts of suicide, a prevention hotline can help. The Suicide and Crisis Lifeline is available 24 hours a day at During a crisis, people who are hard of hearing can use their preferred relay service or dial then Find more links and local resources. It is best for people with BED to talk with a healthcare professional about the potential risks and benefits of antidepressants and other treatments. Visit our dedicated hub for more research-backed information and resources on mental health and well-being. Antidepressants may help with symptoms of binge eating disorder BED. However, they cannot cure the condition. It is important for people to be aware of the potential risks and side effects before starting to take antidepressants for BED. Eating disorders are conditions that involve disordered eating. Learn more about the different types of eating disorder and their associated symptoms…. The signs of an eating disorder vary depending on the condition, but they can include extreme food restriction, food rituals, and anxiety about food. There are many myths about eating disorders, but knowing the facts can help people provide better support for individuals dealing with these serious…. The Overeaters Anonymous step program aims to reduce compulsive eating and food behaviors while maintaining a moderate body weight, but experts are…. There are several possible causes that may make a person unable to stop eating, including disordered eating behaviors, emotional factors, or binge…. My podcast changed me Can 'biological race' explain disparities in health? Why Parkinson's research is zooming in on the gut Tools General Health Drugs A-Z Health Hubs Health Tools Find a Doctor BMI Calculators and Charts Blood Pressure Chart: Ranges and Guide Breast Cancer: Self-Examination Guide Sleep Calculator Quizzes RA Myths vs Facts Type 2 Diabetes: Managing Blood Sugar Ankylosing Spondylitis Pain: Fact or Fiction Connect About Medical News Today Who We Are Our Editorial Process Content Integrity Conscious Language Newsletters Sign Up Follow Us. Medical News Today. Health Conditions Health Products Discover Tools Connect. What to know about antidepressants and binge eating disorder. Medically reviewed by Ifeanyi Olele, DO, MBA, MS — By Tabitha Britt on November 3, Depression and BED Can antidepressants help? Side effects Other treatments Contacting a doctor Summary Healthcare professionals may prescribe antidepressants in addition to psychotherapy to treat binge eating disorder BED. It has been studied in three trials and was associated with reduced binge episodes per week, decreased eating-related obsessions and compulsions, and produced small weight losses. There have been insufficient studies directly comparing medication treatment to psychological treatment for BED , but medications are generally considered less effective than psychotherapy. Thus, they should usually be considered a second-line treatment after psychotherapy, as an adjunct to psychotherapy, or when therapy is inaccessible. The antidepressant bupropion often marketed as Wellbutrin is often prescribed in patients who are trying to lose weight and who may also exhibit depressive symptoms. Wellbutrin has been associated with seizures in patients with purging bulimia, however, and is not recommended for patients with eating disorders. In general, medication is not typically the primary mode of treatment for an eating disorder. Medication may be helpful when added to psychotherapy or when psychotherapy is not available. Further, medication is often used when patients also have symptoms of anxiety and depression to help with these symptoms. However, medications can carry a risk for side effects that are not found with psychological therapies. There are various treatments for eating disorders that are considered efficacious, including cognitive behavioral therapy and family-based treatment. National Institute of Mental Health. Eating disorders. Davis H, Attia E. Pharmacotherapy of eating disorders. Curr Opin Psychiatry. Spettigue W, Norris ML, Maras D, et al. Evaluation of the effectiveness and safety of olanzapine as an adjunctive treatment for anorexia nervosa in adolescents: An open-label trial. J Can Acad Child Adolesc Psychiatry. Bergström I, Crisby M, Engström AM, et al. Women with anorexia nervosa should not be treated with estrogen or birth control pills in a bone-sparing effect. Acta Obstet Gynecol Scand. Crow SJ. Pharmacologic treatment of eating disorders. Psychiatr Clin North Am. Sysko R, Sha N, Wang Y, Duan N, Walsh BT. Early response to antidepressant treatment in bulimia nervosa. Psychol Med. Food and Drug Administration. Highlights of prescribing information: Prozac fluoxetine capsules for oral use. Berkman ND, Brownley KA, Peat CM, Lohr KN, Cullen KE, Morgan LC, Bann CM, Wallace IF, Bulik CM. Management and Outcomes of Binge-Eating Disorder. Rockville MD : Agency for Healthcare Research and Quality US ; Dec. Report No. By Lauren Muhlheim, PsyD, CEDS Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy. Use limited data to select advertising. Create profiles for personalised advertising. Use profiles to select personalised advertising. Create profiles to personalise content. Use profiles to select personalised content. Measure advertising performance. Measure content performance. Understand audiences through statistics or combinations of data from different sources. Develop and improve services. Use limited data to select content. List of Partners vendors. Eating Disorders. By Lauren Muhlheim, PsyD, CEDS. Lauren Muhlheim, PsyD, CEDS. Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy. Learn about our editorial process. Learn more. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Medically reviewed by Rachel Goldman, PhD, FTOS. Learn about our Medical Review Board. Table of Contents View All. Table of Contents. Anorexia Nervosa. Bulimia Nervosa. Binge Eating Disorder. Warning About Wellbutrin. No medication has yet been FDA approved for the treatment of anorexia. 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Antidepressant for eating disorders -
A small open-label study that compared sertraline with a placebo reported that sertraline improved depressive symptoms, perceptions of ineffectiveness, a lack of interoceptive awareness, and perfectionism, but not weight gain [ 25 ]. Overall, the effect of antidepressant in the treatment of AN still remains limited and inconsistent.
Since the rates of dropout from treatment for AN are high, ranging from Although numerous studies have been conducted on the pharmacological treatment of AN, few studies have compared differences in BMI trends among patients receiving a single medication, combined medications or switching medications during the clinical course of AN.
In the current study, we retrospectively reviewed the data of patients diagnosed with AN and compared the BMI course based on medication usage, i. This study aimed to better understand the BMI course trends based on the different patterns of medication usage at various time points in order to improve AN treatment in clinical practice.
During the period —, we retrospectively reviewed the historical data of all patients diagnosed with AN according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition DSM-IV , DSM-5, the International Classification of Diseases, 10th Revision ICD , or the International Classification of Diseases, 11th Revision ICD All data were collected from outpatient records at Taichung Veterans General Hospital, and the standard of care for patients with AN at the hospital is based on evidence-based guidelines and clinical experience.
We only included data from outpatient records and did not include any records from inpatient treatment in our study. There were no patients in our study who received inpatient treatment before transitioning to outpatient treatment.
There were two groups in this study based on the duration of the follow-up period. Group A was a 6-month follow-up group, which comprised 93 patients mean age All descriptive data are listed in Table 1.
Additionally, we adjusted the baseline BMI AN severity by using repeated measures ANOVA in both groups. Please refer to Table 2 for the results. This research was approved by the ethics committee of Taichung Veterans General Hospital and conducted in accordance with Good Clinical Practice procedures and the current revision of the Helsinki Declaration.
Patients with drug treatments were allocated into four categories as follows: with antidepressants, with antipsychotics, switching medication, and combined medication. In Group A 6-month follow-up group , 63 patients were treated with medications, with 42 of these patients with antidepressants, 5 patients with antipsychotics, 5 patients with switching medication, and 11 patients with combined medication.
In Group B month follow-up group , 25 patients were treated with medications, with 17 of these patients with antidepressants, 2 patients with antipsychotics, 4 patients with switching medication, and 2 patients with combined medication.
The choice of antidepressants included four SSRI, i. There was a single choice of antipsychotic medication: sulpiride. There were patients diagnosed with AN who did not receive psychotropic treatment. In Group A 6-month follow-up group , 30 out of 93 patients In Group B month follow-up group , 11 out of 36 patients According to the DSM-5, the diagnostic criteria for AN included restriction of energy intake relative to requirements, leading to a significantly low body weight.
We obtained a series of BMI data from outpatients' medical records. Repeated measures ANOVA was conducted to analyze the BMI measurements taken at the start of medication T0 , at the 3-month follow-up T3 , at the 6-month follow-up T6 , at the 9-month follow-up T9 , and at the month follow-up T The Bonferroni test was used for post-hoc analysis, and IBM SPSS version The software calculation indicated that the power 1-beta error probability is 0.
Table 3 shows the mean and standard deviation of BMI in Group A at three time points T0, T3, and T6. Table 4 shows the mean and standard deviation of BMI in Group B at five time points T0, T3, T6, T9, and T Figures 1 and 2 show the trends in BMI over time in line graphs for Group A and Group B, respectively.
Body mass index group comparison of patients with anorexia nervosa during the 6-month outpatient follow-up. Body mass index group comparison of patients with anorexia nervosa during the month outpatient follow —up. During the 6-month outpatient follow-up Table 3 , patients treated with antidepressants showed a mean BMI increase of 1.
In contrast, patients treated with switching medications showed a mean BMI increase of 0. In the Bonferroni post hoc test, patients treated with antidepressants showed a significant BMI difference between the following time periods T0 vs.
T3, T0 vs. T6, and T3 vs. No significant BMI difference among the other four groups with antipsychotics, switching medications, combined medications, without medications emerged, while the antidepressant group showed a significant difference in BMI for the time periods T0 vs.
During the month outpatient follow-up Table 4 , patients treated with antidepressants showed a mean BMI increase of 2. However, patients treated with antipsychotics showed a mean BMI increase of 2.
In the Bonferroni post hoc test, patients treated with antidepressants showed a significant BMI difference between the following time period: T0 vs.
T6, or T0 vs. T9, T0 vs. T12, T3 vs. T6, T3 vs. T9, T3 vs. T12, and T6 vs. No significant BMI difference among the other four groups with antipsychotics, switching medications, combined medications, without medications emerged, while the antidepressant group showed a significant difference for the following time periods: T0 vs.
To address this, we grouped the samples into two categories: staying on antidepressant or antipsychotic and switching, combining, or not taking medication. This suggests that staying on antidepressant or antipsychotic is more effective in increasing BMI compared to switching, combining, or not taking medication.
Please refer to Table 5 for more details. To our knowledge, this is the first study to retrospectively review BMI courses at five timepoints at the beginning of treatment and at 3, 6, 9, and 12 months after treatment in outpatients with AN receiving different medications.
In our study, patients who adhered to their antidepressant or antipsychotic medication regimens had a significant BMI increase in the 6-month follow-up, compared with patients who switched medication, used combined medication or did not use medication. These findings suggest that medication adherence to a single medication may play a key role in improving BMI in both the antidepressant and antipsychotic groups.
Our study highlights the importance of medication adherence, and the essential role of pharmacotherapy in the treatment of AN. The contributions of this study are further elaborated in the following sections. First, based on the results of our study, it seems that medication adherence is more important than the specific medication in the treatment of patients with AN.
Since the core symptoms of AN are in direct conflict with the medical goal of weight gain, adherence to the therapeutic recommendations presents significant clinical challenges [ 28 ].
However, no significant differences in BMI were found in patients who switched medication, used combined medication or did not use medication. The results suggest that maintaining a consistent medication regimen may be more effective at increasing BMI, compared to switching medications or using a combination of medications.
On the other hand, psychoeducational interventions to enhance medication adherence among patients with AN is critical during the treatment course.
Since the main treatment of AN as delineated in the current international guidelines is a form of psycho-behavioral therapy which can be provided on an outpatient basis [ 13 , 14 , 15 ], specific psychological therapies such as trans-diagnostic Cognitive Behaviour Therapy — Enhanced CBT-E are the first-line treatment for all eating disorders and have the greatest impact on symptom reduction and other outcomes [ 29 ].
Novick et al. That being said, pharmacotherapy may only play an adjunctive role in the treatment of AN, and behavior change and medication adherence are the keys to recovery. Patients with AN have been particularly impaired by poor insight [ 31 ], as this disorder is characterized by distorted cognitions of weight and body shape as well as ambivalence in motivation to recover [ 32 ].
Level of insight has been demonstrated to be of clinical relevance in the treatment and prognosis of psychiatric disorders [ 33 ]. Based on our results, we speculate that medication adherence is mainly accompanied by better quality of insight to the disorder itself, and increased insight may lead to acceptance of weight gain in the clinical course of AN while receiving medication.
Additionally, our study found that patients treated with antidepressants had a significant increase in BMI in the first 3 months T0-T3 and the second 3 months T3-T6. This information may be useful for clinicians in evaluating the effectiveness of medication based on weight change in patients with AN after prescription.
A study reviewed outpatient therapy for patients with AN and found that patients with the greatest early weight gain had significantly higher levels of remission [ 34 ]. Thus, close monitoring in weight change may help clinicians to adjust the treatment plan accordingly, and it must be kept in mind that the association between early weight gain trajectories and the outcome of the disorder seems to be crucial.
However, our findings are inconsistent with the results of recent studies on use of antidepressants in the treatment of AN. In general, there is a lack of solid evidence that antidepressants can improve weight gain in the treatment of patients with AN [ 35 ].
In our study, the choice of antidepressants included four SSRIs, namely fluoxetine, paroxetine, escitalopram, and sertraline, and one NaSSA mirtazapine.
Fluoxetine is one of the most-studied SSRIs in AN and seems to have the most evidence supporting its use in the treatment of AN in weight-restored individuals [ 24 ]. Kaye et al. However, in the study no control subjects were investigated, and the results were comparable with data from the literature.
In contrast, Holtkamp et al. In the study, both SSRI and non-SSRI groups showed a similar course of BMI at the 3-month and 6-month follow-up. The inconsistent evidence on the effectiveness of antidepressants in treating AN patients necessitates the need for additional studies with a larger sample size and longer follow-up duration.
Antipsychotics have also been suggested as a potential treatment option for AN. In our study, the use of antipsychotics was found to result in a significant increase in BMI after 6 months, but not after 12 months.
This may be due to the limited sample size in the month follow-up, the choice of antipsychotics, and the fact that antipsychotics did not address the comorbid depression and anxiety associated with AN. Additionally, the antipsychotic used in our study was sulpiride, rather than the more commonly studied second-generation antipsychotic SGA olanzapine.
Few studies on first-generation antipsychotics FGAs have been conducted on AN patients due to its severe side effects, such as grand mal seizure, which may occur in patients taking chlorpromazine [ 38 ]. A double-blind, placebo-controlled, cross-over study [ 39 ], which included 18 female AN inpatients revealed that sulpiride was superior to placebo for daily weight gain, especially in the first treatment period of three weeks.
However, in the cross over analysis, this effect did not reach statistical significance. The absence of supporting evidence for the effectiveness of sulpiride in treating AN patients necessitates the need for more robust and high-quality research in order to offer practical guidance to clinicians.
Second, our study found that the BMI of patients in the switching medication group did not increase. The results suggest that frequent switching of medications may not be beneficial for weight gain and may also require a re-establishment of rapport with patients with AN. Switching medications can have a significant impact on the patient-doctor relationship, as it often involves discussing the current treatment plan, evaluating its effectiveness, and making changes to better meet the patient's needs.
This process requires open communication, trust, and collaboration between the patient and doctor, which can help to re-establish and strengthen the relationship between them.
However, there is a possibility that the poorer outcome in the "switch medication" group may simply reflect that this group was more medication resistant, rather than the switch itself causing the poorer outcome.
Unless the clinical situation requires a medication change, prescribers may take steps to optimize current medication regimens e. In clinical practice, taking the time to understand a patient's motivations for wanting to discontinue or switch medications and approaching medication changes with caution can be beneficial.
This is because changes in medication often result in the need to re-establish the patient-doctor relationship. Third, in our study, pharmacotherapy was found to be superior to no medication in treating AN patients..
This may be due to the fact that antidepressants effectively address the underlying depression and anxiety issues in AN patients. Although recent studies on pharmacotherapy show inconsistent evidence regarding improvements in weight gain in patients with AN, a number of the symptoms frequently associated with AN, such as depression and anxiety are responsive to medications [ 21 ].
As recommended by most guidelines, it is important to consider the overall picture of the patient, including their psychiatric, medical, nutritional, and social circumstances. Apart from specific psychological therapy, the treatment needs to be provided by a multidisciplinary team to address important nutritional, physical and mental health comorbidities [ 41 ].
It is important to note that, due to the naturalistic study design different medications at different dosages, non-randomized , our findings are preliminary and should be interpreted with caution.
There are also several limitations to this study that should be considered. First, although we assessed BMI, our study lacked other clinical evaluations commonly seen in AN, such as eating disorder psychopathology, depressive symptomatology, and obsessive—compulsive symptomatology.
Besides, since patients with AN are prone to have other psychiatric and medical comorbidities, the complete information of these comorbidities may be further addressed in detail but it is lacking in our study. Second, our study lacked long-term BMI follow-up.
The observation periods of the BMI course were short, with follow-up at 6 months and 12 months only. Therefore, further well-controlled studies with a larger sample size and a longer follow-up period are required to confirm our findings.
Fourth, there are many other possible factors that might be related to BMI fluctuation in patients with AN. For example, the poorer outcome in the "switch medication" group may simply reflect that this group was more medication resistant, rather than the switch itself causing the poorer outcome.
Whether patients receive nonpharmacological interventions psychotherapy, family therapy, etc. or whether patients receive medical treatments from internal medicine specialists may contribute to BMI change. Comprehensive information of all kinds of treatment for patients with AN should be considered in the future study.
Fifth, in our study, we considered patients with AN who came back to the outpatient department routinely for prescription are those patients who were taking medication regularly. However, patients with AN are notorious for their poor medication compliance, so appropriate measurement of medication adherence such as self-report questionnaires or structured interviews should be included.
AN is a disease caused by various factors. It is necessary to evaluate the long-term prognosis of AN. This study provides a direction that warrants further exploration.
Our study highlights three key findings: 1 medication adherence is more critical than the specific medication in treating AN patients, 2 frequent switching of medications may not promote weight gain and may also require a re-establishment of rapport with patients with AN, and 3 pharmacotherapy, particularly the use of antidepressants, is more beneficial than no medication at all in addressing the depression and anxiety symptoms in AN patients.
Further studies with a larger sample size and longer follow-up period are required to confirm our findings. All data generated or analyzed during this study are included in this published article and its supplementary information files.
Solomon CG, MitchellPeterson JECB. Anorexia nervosa. N Engl J Med. Article Google Scholar. American Psychiatric Association.
Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing; Book Google Scholar. Moore CA, Bokor BR. In StatPearls: Stat- Pearls Publishing; Google Scholar. Eddy KT, Dorer DJ, Franko DL, Tahilani K, Thompson-Brenner H, Herzog DB.
Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. Am J Psychiatry. Article PubMed PubMed Central Google Scholar. Peat C, Mitchell JE, Hoek HW, Wonderlich SA. Validity and utility of subtyping anorexia nervosa. Int J Eat Disord. Reas DL, Rø Ø. Eat Behav. Article PubMed Google Scholar.
Serra R, Di Nicolantonio C, Di Febo R, De Crescenzo F, Vanderlinden J, Vrieze E, Tarsitani L. The transition from restrictive anorexia nervosa to binging and purging: a systematic review and meta-analysis. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity.
Errichiello L, Iodice D, Bruzzese D, Gherghi M, Senatore I. Prognostic factors and outcome in anorexia nervosa: a follow-up study. Eat Weight Disord-Stud Anorexia, Bulimia Obesity. Zipfel S, Löwe B, Reas DL, Deter H-C, Herzog W.
Long-term prognosis in anorexia nervosa: lessons from a year follow-up study. The Lancet. Article CAS Google Scholar. Kaufmann L-K, Moergeli H, Milos GF. Lifetime weight characteristics of adult inpatients with severe anorexia nervosa: maximal lifetime BMI predicts treatment outcome.
Front Psychiatry. Blanchet C, Guillaume S, Bat-Pitault F, Carles M-E, Clarke J, Dodin V, Iceta S. Medication in AN: a multidisciplinary overview of meta-analyses and systematic reviews.
J Clin Med. Wild B, Friederich H-C, Zipfel S, Resmark G, Giel K, Teufel M, Zeeck A. Predictors of outcomes in outpatients with anorexia nervosa—Results from the ANTOP study. Psychiatry Res. National Institute for Health and Care Excellence. Eating disorders: recognition and treatment: NICE guideline, No.
Resmark G, Herpertz S, Herpertz-Dahlmann B, Zeeck A. Treatment of anorexia nervosa—new evidence-based guidelines. Yager J, Andersen A, Devlin M, Egger H, Herzog D, Mitchell J, Zerbe K. Practice guideline for the treatment of patients with eating disorders.
Am Psychiatr Assoc. Flückiger C, Del Re A, Wlodasch D, Horvath AO, Solomonov N, Wampold BE. Assessing the alliance—outcome association adjusted for patient characteristics and treatment processes: A meta-analytic summary of direct comparisons.
J Couns Psychol. Werz J, Voderholzer U, Tuschen-Caffier B. Alliance matters: but how much? A systematic review on therapeutic alliance and outcome in patients with anorexia nervosa and bulimia nervosa. Eat Weight Disord-Stud Anorexia, Bulimia Obes.
Steinglass JE, Eisen JL, Attia E, Mayer L, Walsh BT. Is anorexia nervosa a delusional disorder? An assessment of eating beliefs in anorexia nervosa. J Psychiatr Pract. Attia E, Steinglass JE, Walsh BT, Wang Y, Wu P, Schreyer C, Kaplan AS.
Olanzapine versus placebo in adult outpatients with anorexia nervosa: a randomized clinical trial. Han R, Bian Q, Chen H. Effectiveness of olanzapine in the treatment of anorexia nervosa: A systematic review and meta-analysis.
Brain Behav. Muratore AF, Attia E. Current therapeutic approaches to anorexia nervosa: State of the art. Clin Ther. Hrdlicka M, Beranova I, Zamecnikova R, Urbanek T.
Mirtazapine in the treatment of adolescent anorexia nervosa. Eur Child Adolesc Psychiatry. Holtkamp K, Konrad K, Kaiser N, Ploenes Y, Heussen N, Grzella I, Herpertz-Dahlmann B.
A retrospective study of SSRI treatment in adolescent anorexia nervosa: insufficient evidence for efficacy. J Psychiatr Res. Article CAS PubMed Google Scholar. Marvanova M, Gramith K. Cyproheptadine — Is an antihistamine that stimulates appetite and may help relieve depression associated with appetite loss and improve appetite for people with anorexia.
Zyprexa Olanzapine — People with anorexia often experience intense anxiety and subsequent depression in regard to food,their body weight, and eating.
Since adopting healthier dietary habits is key toward managing and recovering from anorexia, medications that help alleviate anxiety may prove useful in treating emotional aspects of the disorder.
Zyprexa is a medication formerly used to treat schizophrenia and may improve treatment for low-weight anorexia patients. Olanzapine works by reducing anxiety, obsessive thinking, and depression caused by these symptoms. Antidepressants regulate brain chemicals that control mood.
Guilt, anxiety, and depression about binging usually lead to purging. Antidepressants help keep emotions stable and can help reduce the frequency of binge-purge cycles. Antidepressants work best when combined with psychological counseling for the treatment of bulimia.
The antidepressants that are most commonly used to reduce the binge-purge cycle associated with bulimia is Prozac aka Fluoxetine. Prozac is a selective serotonin reuptake inhibitor SSRI. Prozac has proven to reduce binge-purge cycles in bulimia. Antidepressant medicines may reduce episodes of binge eating in those who have binge eating disorder, and they may help with related depression or anxiety.
They can help reduce the compulsive behavior that leads to binging. These drugs can also help people who have both depression and binge eating disorder. It may take several weeks for antidepressants to relieve symptoms associated with binge eating disorder, although they may become effective sooner.
You may need to continue taking antidepressants over a long period of time to prevent a relapse. Antidepressants that have been proven effective in treating binge eating disorder include Bulimia Nervosa Binge Eating — Prozac fluoxetine — Luvox fluvoxamine. Some antidepressants can have serious interactions with other medicines or dietary supplements.
Antidepressants may produce some side effects. But side effects may be reduced or may go away after several weeks of treatment. SSRIs have less serious side effects and are less dangerous in case of an overdose.
Although side effects of SSRIs are usually mild, they can include nausea, loss of appetite, diarrhea, anxiety, irritability, problems sleeping or drowsiness,loss of sexual desire or ability, headaches, dizziness, and dry mouth. After several weeks of treatment, SSRI side effects may be less or may go away completely.
Tricyclic — Tricyclic side effects can include stomach upset, constipation, dry mouth, blurred vision, and drowsiness.
Medical Treatment Antidpressant Fat blocker metabolism booster eating disorders need to see a eatimg in person on dor regular Diet and fitness tracking app. The doctor can watch for and treat any physical Fat blocker metabolism booster that are a result of their illness. Children and youth also need to be carefully monitored to make sure they are growing and developing at a normal rate. Medications The treatment plan for eating disorders sometimes includes medications. They are usually offered in addition to family or individual based psychotherapy. Medications can help people with eating disorders who are struggling with other mental health symptoms, like anxiety or depression.
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