Pharmacotherapy (the use of medication) is in general only minimally helpful for patients with anorexia nervosa. There are no studies demonstrating that any medication leads to recovery from anorexia. Many medications have been tried, including Selective Serotonin Reuptake Inhibitors (Prozac, Zoloft, Celexa, Lexapro) lithium, marijuana, Clonidine, Reglan, Propulsid, and Naltrexone, but none have been shown to be effective. The atypical antipsychotic medications (Zyprexa, Seroquel, Risperdol, Abilify) have been utilized in several trials for anorexia. They have not been shown to result in recovery.
Although not successful in producing recovery, medications may be indicated as part of a broader treatment program for anorexia. In this context a broader treatment plan means that the level of care is an intensive outpatient or a day treatment program with the presence of a multidisciplinary team including a dietitian, psychiatrist, primary care physician, and therapist. A multidisciplinary treatment team must be involved any time medication is utilized since it should only be used as an adjunct to treatment.
Within this context, two groups of medication are sometimes helpful.
- Benzodiazepines, which are primarily used to target anxiety. Anxiety disorders may be comorbid with anorexia as high as 50% of the time, and the process of refeeding often increases anxiety as well. In these situations as part of the overall treatment plan, benzodiazepines (Ativan, Xanax, Kolonopin) may be useful. These medications are potentially addictive and may cause physiological dependence. Therefore, although they have the potential to be helpful, one must be cautious when taking these medications.
- The atypical antipsychotics have also been shown to have value for some patients with anorexia. These can be helpful for patients whose eating disorder has aspects of obsessive compulsive disorder or delusional thinking. They may also be prescribed for clients whose anxiety or agitation around food issues may be so profound that they must be utilized for the client to have the ability to engage in other treatment. There are concerns about these medications causing weight gain due to overeating in some patients. To date this has not been shown to be the usual experience of patients with anorexia. We do not use these medications to facilitate weight gain.
Of special note: the Selective Serotonin Reuptake Inhibitors (SSRIs) are often ineffective when someone is at a low body weight. At a low body weight a person has diminished protein synthesis, diminished neurotransmitters, and therefore diminished ability to benefit from these medications. One may also see increased toxicity at a low weight, including gastrointestinal side effects. There is some evidence, however, that SSRIs may help prevent relapse once weight is restored.
For more information on medications used in the treatment of eating disorders visit: http://www.something-fishy.org/doctors/medications.php
Next week: Medication and the Treatment of Bulimia Nervosa
Contributions by Sarah Emerman