Pharmacological treatment in patients with anorexia nervosa
Keywords:
eating disorder, anorexia nervosa, antidepressant, antipsychoticAbstract
Treatment for anorexia nervosa (AN) eating disorder consists of multidisciplinary approaches including medical managements, nutritional interventions, psychological therapy, cognitive behavioral therapy, family-based therapy, and pharmacological treatment to improve signs and symptoms of the disease. No medication has currently been approved for AN treatment yet. This article reviews the randomized controlled clinical trials; both inpatient and outpatient settings, that evaluated the medication uses including antidepressants, antipsychotics, and others for weight gain and psychological impacts in AN patients. The current literature data indicates no significant effects of antidepressants; compared to standard care, on weight gain and psychological symptoms. Atypical antipsychotics; especially olanzapine at the dose of 2.5-10 mg/day, are the most studied with conflicting results and no definitive benefit has been drawn. Most of the reported adverse symptoms of olanzapine is drowsiness. The limitations of literatures are small sample sizes and high drop-out rate; particularly in the outpatient settings, leading the impractically reliable statistical analysis. The duration of most studies was less than 16 weeks, so long-term effects of pharmacological treatment were lacking. The overall patient’s medication adherence was not clear. Due to complexity of patient and disease factors, the medications should not be used as the sole treatment in patients with AN. The patient should be individually evaluated for the need for medication. When prescribing medication for patient with AN, closely monitoring of efficacy, safety, and adherence for individual patient are required.
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