What are the medications for anorexia nervosa?

From the Guidelines

Medications for anorexia nervosa should be used as part of a comprehensive treatment plan that includes nutritional rehabilitation, psychotherapy, and medical monitoring, with selective serotonin reuptake inhibitors (SSRIs) like fluoxetine being considered for co-occurring depression and anxiety 1. When considering medication for anorexia, it's crucial to prioritize a comprehensive approach that addresses the psychological, nutritional, and behavioral aspects of the disorder.

• The American Psychiatric Association recommends that patients with anorexia nervosa have individualized goals set for weekly weight gain and target weight, and be treated with an eating disorder-focused psychotherapy 1.
• Medications such as SSRIs, atypical antipsychotics, and mood stabilizers may be used to help manage co-occurring conditions like depression and anxiety, but should not be relied upon as the sole treatment for anorexia.
• The use of medications like fluoxetine at doses of 20-60mg daily may help with co-occurring depression and anxiety, particularly during weight restoration 1.
• It's essential to note that medication alone is insufficient for treating anorexia, and treatment typically continues for at least 6-12 months after weight restoration, with regular monitoring of vital signs, electrolytes, and cardiac function due to the physical complications of anorexia and potential medication side effects.
• A comprehensive treatment plan should incorporate medical, psychiatric, psychological, and nutritional expertise, commonly via a coordinated multidisciplinary team 1.

From the Research

Medication for Anorexia

• Anorexia nervosa (AN) is a severe psychiatric disorder that is difficult to treat and is associated with frequent relapses and high mortality rates 2.
• Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), may be used as adjunctive treatment to psychotherapy for relapse prevention, improvement of depressive and anxiety symptoms, and/or obsessive-compulsive behaviors unresolved with nutritional rehabilitation and psychotherapy 2, 3, 4.
• The use of SSRIs, such as fluoxetine, sertraline, citalopram, or mirtazapine, may aid in relapse prevention and improvement of psychiatric symptomatology in weight-restored anorexic patients 2, 4.
• Tricyclic antidepressants and monoamine oxidase inhibitors are not recommended due to safety concerns, and bupropion is contraindicated 2.
• The treatment of AN is intricate and requires a holistic approach, including nutritional rehabilitation, psychosocial, and pharmacological therapies, and an interdisciplinary team of medical professionals is recommended 5, 6.

Types of Medication

• Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that have been found to be effective in AN, especially in preventing relapse 3, 4.
• Fluoxetine is a commonly used SSRI in the treatment of AN, and it may significantly reduce the high rate of relapse normally seen in AN when given after weight restoration 4.
• Other SSRIs, such as sertraline, citalopram, and mirtazapine, may also be effective in the treatment of AN, although more research is needed to confirm their efficacy 2, 4.

Limitations and Considerations

• The use of antidepressants in AN is complicated by the fact that they are often given together with other therapies, making it difficult to discern their efficacy 2.
• Neurobiological changes due to starvation and AN itself can complicate the interpretation of results 2.
• The treatment of AN should be individualized and tailored to the specific needs of each patient, taking into account their medical and psychiatric history, as well as their personal preferences and values 5, 6.