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There is extensive evidence available for the use of medicines to treat atypical eating disorders.
There is extensive evidence available for the use of medicines to treat atypical eating disorders.
False
For anorexia nervosa, psychological interventions are the treatments of choice.
For anorexia nervosa, psychological interventions are the treatments of choice.
True
Fluoxetine is recommended as a treatment for bulimia nervosa according to NICE guidance.
Fluoxetine is recommended as a treatment for bulimia nervosa according to NICE guidance.
True
Lisdexamfetamine is an option for the treatment of anorexia nervosa.
Lisdexamfetamine is an option for the treatment of anorexia nervosa.
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An evidence-based self-help programme of cognitive behavioural therapy is recommended as the first choice of treatment for binge eating disorder.
An evidence-based self-help programme of cognitive behavioural therapy is recommended as the first choice of treatment for binge eating disorder.
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In the absence of evidence to guide the management of other atypical eating disorders, the clinician should follow guidance of the eating disorder that mostly resembles the patient's eating disorder.
In the absence of evidence to guide the management of other atypical eating disorders, the clinician should follow guidance of the eating disorder that mostly resembles the patient's eating disorder.
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The lifetime risk of any eating disorder is 8.4% in women and 2.2% in men.
The lifetime risk of any eating disorder is 8.4% in women and 2.2% in men.
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Structured psychotherapy is one of the main interventions for anorexia nervosa.
Structured psychotherapy is one of the main interventions for anorexia nervosa.
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Olanzapine has shown a significant effect over placebo in weight restoration for anorexia nervosa.
Olanzapine has shown a significant effect over placebo in weight restoration for anorexia nervosa.
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Dronabinol, a synthetic cannabinoid agonist, is recommended for weight gain in anorexia nervosa despite common adverse effects.
Dronabinol, a synthetic cannabinoid agonist, is recommended for weight gain in anorexia nervosa despite common adverse effects.
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Patients with anorexia nervosa should have an alert in their prescribing record indicating an increased risk of arrhythmias.
Patients with anorexia nervosa should have an alert in their prescribing record indicating an increased risk of arrhythmias.
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Healthcare professionals do not need to monitor ECG in patients with anorexia nervosa who are prescribed medications affecting cardiac function.
Healthcare professionals do not need to monitor ECG in patients with anorexia nervosa who are prescribed medications affecting cardiac function.
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Treatment with a multivitamin/multimineral supplement is recommended only for inpatient weight restoration in anorexia nervosa.
Treatment with a multivitamin/multimineral supplement is recommended only for inpatient weight restoration in anorexia nervosa.
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Rapid correction of hypophosphataemia in patients with anorexia nervosa is considered safe and effective.
Rapid correction of hypophosphataemia in patients with anorexia nervosa is considered safe and effective.
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Fluoxetine is consistently found to be beneficial in preventing relapse of anorexia nervosa after weight restoration.
Fluoxetine is consistently found to be beneficial in preventing relapse of anorexia nervosa after weight restoration.
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Bupropion is recommended for co-morbid major depression in anorexia nervosa due to its minimal side effects.
Bupropion is recommended for co-morbid major depression in anorexia nervosa due to its minimal side effects.
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Psychological interventions are considered the first line treatment for bulimia nervosa.
Psychological interventions are considered the first line treatment for bulimia nervosa.
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Topiramate has limited evidence supporting its effectiveness in reducing binge-eating frequency.
Topiramate has limited evidence supporting its effectiveness in reducing binge-eating frequency.
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Citalopram is more effective than fluoxetine for depressive symptoms in bulimia nervosa patients.
Citalopram is more effective than fluoxetine for depressive symptoms in bulimia nervosa patients.
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SSRIs are recommended as the first choice antidepressant for adults with bulimia nervosa and binge eating disorder.
SSRIs are recommended as the first choice antidepressant for adults with bulimia nervosa and binge eating disorder.
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Lisdexamfetamine is approved for treating binge eating disorder in the USA.
Lisdexamfetamine is approved for treating binge eating disorder in the USA.
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Antidepressants are licensed and recommended as first line treatment for adolescent bulimia nervosa.
Antidepressants are licensed and recommended as first line treatment for adolescent bulimia nervosa.
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If supplements are used, it is necessary to monitor glucose levels.
If supplements are used, it is necessary to monitor glucose levels.
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Bone loss is a severe complication of anorexia with significant consequences.
Bone loss is a severe complication of anorexia with significant consequences.
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Hormonal treatment using oestrogen has a positive impact on bone density in children and adolescents.
Hormonal treatment using oestrogen has a positive impact on bone density in children and adolescents.
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Antipsychotics that raise prolactin levels can reduce the risk of bone loss.
Antipsychotics that raise prolactin levels can reduce the risk of bone loss.
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Bisphosphonates are generally recommended for women with anorexia nervosa.
Bisphosphonates are generally recommended for women with anorexia nervosa.
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NICE found substantial evidence to support the use of antidepressants for anorexia nervosa.
NICE found substantial evidence to support the use of antidepressants for anorexia nervosa.
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Antipsychotics are often used to reduce anxiety in patients with anorexia nervosa.
Antipsychotics are often used to reduce anxiety in patients with anorexia nervosa.
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Olanzapine is shown to have no impact on weight restoration in patients with anorexia nervosa.
Olanzapine is shown to have no impact on weight restoration in patients with anorexia nervosa.
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Study Notes
Relapse Prevention
- Fluoxetine may be useful in improving outcome and preventing relapse of patients with anorexia nervosa after weight restoration.
- SSRIs can elevate prolactin levels, albeit rarely.
Co-morbid Disorders
- Antidepressants are often used to treat co-morbid major depression and obsessive-compulsive disorder.
- Caution should be used as these conditions may resolve with weight gain alone.
- Bupropion is contraindicated for the treatment of co-morbid depression in anorexia nervosa due to its frequent side effect of weight loss.
- Mania and psychosis occurring in the context of anorexia nervosa are probably best treated with olanzapine, and bipolar depression with olanzapine + fluoxetine.
Bulimia Nervosa and Binge Eating Disorder
- Psychological interventions should be considered first line for bulimia nervosa.
- Adults with bulimia nervosa and binge eating disorder may be offered a trial of an antidepressant.
- SSRIs (specifically fluoxetine) are the antidepressants of first choice.
- The effective dose of fluoxetine is 60mg daily.
- Early response (at 3 weeks) is a strong predictor of response overall.
- Antidepressants may be used for the treatment of bulimia nervosa in adolescents, but they are not licensed for this age group, and there is little evidence for this practice.
- Topiramate reduces the frequency of binge-eating, but it is often poorly tolerated.
- Lisdexamfetamine is approved for binge eating disorder in the USA.
- There is some evidence for the use of a slow release combination of phentermine and topiramate.
- The noradrenaline/dopamine reuptake inhibitor dasotraline may also be effective, but its development ceased in 2020.
Co-morbid Depression
- Depression is a frequent co-morbidity in bulimia nervosa and binge eating disorder.
- Citalopram has been shown to be more effective than fluoxetine for depressive symptoms in bulimia nervosa patients.
- Mirtazapine should be avoided or used with caution for the treatment of co-morbid depression in binge eating disorder due to its frequent side effect of weight gain.
Other Atypical Eating Disorders
- There have been no useful studies of the use of medicines to treat atypical eating disorders other than anorexia nervosa and binge eating disorder.
- In the absence of evidence, the clinician should consider following the guidance of the eating disorder that most closely resembles the individual patient's eating disorder.
Summary of NICE Guidance on Eating Disorders
- Anorexia nervosa: psychological interventions are the treatments of choice, and no pharmacological intervention is recommended.
- Bulimia nervosa: an evidence-based self-help programme or cognitive behaviour therapy should be the first choice of treatment, followed by a trial of fluoxetine.
- Binge eating disorder: an evidence-based self-help programme or cognitive behaviour therapy should be the first choice of treatment, followed by a trial of an SSRI, or lisdexamfetamine.
Eating Disorders
- The incidence of eating disorders continues to increase.
- Lifetime risk of any eating disorder is 8.4% in women and 2.2% in men.
- Other psychiatric conditions often coexist with eating disorders, which may explain the benefit sometimes seen with medication.
- Any medicine prescribed should be accompanied by close monitoring to check for possible adverse reactions.
Anorexia Nervosa (AN)
- Drugs have limited activity in anorexia nervosa, and none is currently licensed for this condition.
- Prompt weight restoration to a safe weight, family therapy, and structured psychotherapy are the main interventions.
- The aim of treatment is to improve nutritional health through re-feeding with very limited evidence to support the use of any pharmacological interventions.
- Medicines may be used to treat co-morbid conditions, but have a very limited role in weight restoration.
- Olanzapine is the only drug suggested to have any effect on weight restoration in anorexia nervosa.
- Dronabinol, a synthetic cannabinoid agonist, may induce slight weight gain but is not recommended due to its adverse effects.
Physical Aspects
- Vitamins and minerals: treatment with a multivitamin/multimineral supplement in oral form is recommended during both inpatient and outpatient weight restoration.
- Electrolytes: electrolyte disturbances may develop slowly over time and may be asymptomatic, resolving with re-feeding.
- Hypophosphataemia may be precipitated by re-feeding, and rapid correction may be hazardous.
Supplementation
- If supplements are used, urea and electrolytes, HCO3, Ca, P, and Mg need to be monitored, and an ECG needs to be performed.
Osteoporosis
- Bone loss is a serious complication of anorexia nervosa with serious consequences.
- Hormonal treatment using oestrogen or dehydroepiandrosterone (DHEA) does not have a positive impact on bone density.
- Antipsychotics that raise prolactin levels can further increase the risk of bone loss and osteoporosis.
- Bisphosphonates are not generally recommended for women with anorexia nervosa due to the lack of data about both benefits and safety.
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Description
Learn about the use of antidepressants in treating anorexia nervosa, including relapse prevention and co-morbid disorders such as major depression and obsessive-compulsive disorder.
