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Anorexia nervosa has been recognized by physicians for more than
a century, but there is still no generally accepted pharmacologic treatment.
Anorexia Nervosa can lead to significantly impaired functioning in its
victims along with a considerable morbidity. The pursuit of thinness is
the central feature of AN, and the patients usually have a variety of other
psychological disorders which makes treatment very challenging and difficult.
No medication has proven to be generally useful in promoting or maintaining
weight gain, thus cognitive-behavioral therapy remains the cornerstone
of treatment. (Hoffman et al)
According to Dr. Philip W. Long, "A therapist must win the cooperation of the patient by emphasizing that treatment can free the patient from the obsessive thoughts about food and body weight that have become the sole focus of the patient's life." In addition, depression, physical well-being, and social relationships can be improved through various treatments.
(http://www.
mentalhealth.com/rx/p23-et01.html#Head_1c)
Many medications have been used in the treatment of Anorexia Nervosa.
Of these different pharmacological treatments, there have been very few
large scale, controlled studies demonstrating their effectiveness. Several
of these medications, however, have proved useful in facilitating weight
gain during the nutritional rehabilitation phase of treatment. This website
discusses these different treatments, explains why they were used and their
possible side effects, and the overall validity of their effectiveness
as a treatment.
The most common form of this drug which is administered to AN patients
is chlorpromazine. If prescribed, it is usually given to severely obsessive-compulsive,
anxious, and agitated AN patients. This drug is a neuroleptic or dopamine
antagonist in the brain, and the theory which serves as the basis of this
treatment revolves around the idea that certain characteristics of anorexia
nervosa might reflect central nervous system dopaminergic activity. Some
scientists theorize that these dopaminergic activities cause this eating
disorder among other things. In certain clinical experiences, chlorpromazine
has been shown to be somewhat effective in inducing hunger and weight gain,
but others have shown no such effects along with some serious side effects.
These include grand mal seizures and in increase in the development of
bulimia.
In summary, there is an absence of clear evidence as to the effectiveness
of this drug as a treatment and with its potential for unwanted side effects,
it is rarely used. (Walsh and Devlin)
A strong tie between anorexia nervosa and depression has been established
for years. Malnutrition, emaciation, a distorted body image, a perfectionist
family and a myriad of other conditions can produce a psychological profile
which enmeshes anorexia nervosa and depression. Moreover, depression occurs
far more frequently in anorectic patients than in the general population.
Thus, many antidepressants have been shown to be an effective component
of the overall treatment of certain anorectics.
Tricyclic antidepressants, such as clomipramine and amitriptyline,
have been prescribed to anorectics. In different studies comparing them
to placebo drugs, little significant differences between them were found.
When dosages were raised, there was a faster bodyweight gain than with
placebo, but the medication produced problematic adverse effect including
sedation, tachycardia, constipation, dry mouth and confusion. (Crow &
Mitchell 375)
Mixed reviews have also been found with cyproheptadine (an antihistimine
and seratonin antagonist). Basic research has suggested that central seratonin
systems are important in the regulation of feeding behavior. In brief,
increased availability of seratonin in the hypothalamus tends to decrease
food consumption. Therefore, this seratonin antagonist should be useful
in increasing caloric intake. Of four major studies done by various doctors,
only two showed modest benefits from active medication. This drug, however,
significantly slowed the recovery of the bulimic subgroup of patients with
Anorexia Nervosa. (Crow & Mitchell 376)
Flouxetine, another inhibitor of serotonin re-uptake, has been proven
effective in the treatment of obsessive-compulsive disorder as well as
depression. Different studies have shown that those patients who were administered
flouxetine not only experienced an improvement in their depression but
most gained weight as well. There are little if any side effects associated
with this drug, and studies are pending as to its overall efficacy. (Hoffman
& Halmi 769) A study done in 1991 by the University of Pittsburgh showed
that flouxetine may help patients with anorexia nervosa maintain a healthy
body weight as outpatients by improving eating behavior and/or reducing
obsessionality, depression, and anxiety. It is stressed, however, that
fluoxetine should not be used as the sole treatment. (Kaye et al.)
Cisapride & Erythromycin- In primary anorexia nervosa, gastric
motility is often impaired and ensuing symptoms further discourage eating.
These drugs accelerate gastric emptying and thereby enhance gastric motor
activity, thus alleviating the symptoms of gastric retention and changing
eating behavior. There has been some clinical evidence of this theory,
but it has not been proven to be totally effective. (Stacher et al)
Zinc Supplementation- Zinc Supplementation of anorexia nervosa has
been reported to increase the weight gain of patients. This theory regarding
the supplementation of zinc came about because of its association with
weight loss, disorders of appetite and food intake, skin abnormalities,
amenorrhea, and depression;the population most at risk for anorexia nervosa.
Studies have shown that zinc supplementation of anorexia nervosa patients
improved their weight gain and because of its low cost and low potential
for side effects, it is a viable supplement to be considered with standard
treatment. (Birmingham et al)
Many medications may be useful in treating certain patients with
anorexia nervosa and its associated psychological disorders. However, it
is difficult to predict who should receive which medication and how effective
it will be. Furthermore, the potential for serious side effects must be
carefully considered for patients who are very sick and emaciated. The
importance of a comprehensive plan (family, behavioral, etc.) is the key
here as no pharmacological treatment has been proven to be a cure for anorexia
nervosa. In patients who have failed many other treatments, however, it
is worthwhile to consider drug intervention a part of this comprehensive
treatment plan.
Bibliography
Hoffman,L. and Halmi, K., Psychopharmacology in the treatment of
anorexia nervosa and bulimia nervosa, Psychiatric Clinics of North America.
16(4):767-78, 1993 Dec.
http://www.mentalhealth.com/rx/p23-et01.html#Head_1c
Walsh, B.T. and Devlin, MJ., The pharmacological treatment of eating disorders, Psychiatric Clinics of North America. 15(1):149-60, 1992 Mar.
Crow, SJ. and Mitchell, JE., Rational therapy of eating disorders, Drugs. 48(3):372-9, 1994 Sep.
Kaye WH., Weltzin TE., Hsu LK., and Bulik CM., An open trial of fluoxetine in patients with anorexia nervosa, Journal of Clinical Psychology. 52(11):464-71, 1991 Nov.
Stacher G., Abatzi-Wenzel TA., Wiesnagrotzki S., Bergmann H., Schneider C., Gaupmann G., Gastric emptying, body weight and symptoms in primary anorexia nervosa, British Journal of Psychiatry. 162:398-402, 1993 Mar.
Birmingham CL., Goldner EM., Bakan R., Controlled trial of zinc supplementation in anorexia nervosa, International Journal of Eating Disorders. 15(3):251-5, 1994 Apr.
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