Scholarly Article Questions Psychotropic Medication Use for AnorexiaBy: Dr David Herzog

Scholarly Article Questions Psychotropic Medication Use for Anorexia

The Use of Antidepressant and Atypical Antipsychotic Medications in the Treatment of Anorexia Nervosa

Scholarly Article Questions Psychotropic Medication Use for Anorexia

Anorexia nervosa is a psychiatric disorder characterized by extreme self-imposed weight loss and intense fear of gaining weight. It is critical to find effective treatment strategies for this illness because it is associated with a high risk of relapse and with a mortality rate approaching four to ten times that expected for individuals the same age in the general population. Antidepressants, particularly SSRIs (selective serotonin reuptake inhibitors) and antipsychotic medications are commonly prescribed in the treatment of anorexia nervosa; yet there is no conclusive evidence that individuals with anorexia benefit from these medications.

Scholarly Article Questions Psychotropic Medication Use for Anorexia

In order to investigate changes in medication use, Dr. David Herzog – together with the researchers in the Massachusetts General Hospital Neuroendocrine Unit – analyzed data on 520 women with anorexia nervosa who presented for treatment over the course of a 13-year period. The participants were divided into two groups: Group I included those who presented between 1997 and 2002 (n=325), and Group II included those who presented between 2003 and 2009 (n=200). All subjects had a complete medical history and physical exam performed by a physician, physician’s assistant, or nurse practitioner. Data obtained included age of onset of anorexia nervosa, duration of the illness, and current medication use .

Scholarly Article Questions Psychotropic Medication Use for Anorexia

Of the subjects examined, 53% reported current use of any psychotropic medication; 48.4% reported use of an antidepressant and 13% reported use ofan antipsychotic . The use of antidepressants remained stable over the 13-year period, and the rate of atypical antipsychotic use doubled over this time period .

Scholarly Article Questions Psychotropic Medication Use for Anorexia

These findings are worrisome because antidepressants and atypical antipsychotics have been not been shown to be efficacious in anorexia and because these medications have potential adverse effects. Women with anorexia are at risk for severe bone loss. Nearly 90% of women with this disorder have some degree of bone loss with 30% meeting criteria for osteoporosis. Both SSRIs and atypical antipsychotics may negatively impact bone health and increase fracture risk.

Scholarly Article Questions Psychotropic Medication Use for Anorexia

Longer-term studies are needed to evaluate the efficacy and benefit of these medications prior to their continued wide-spread use.