What is the treatment for anorexia?

From the Guidelines

The treatment for anorexia should prioritize a comprehensive approach combining psychological therapy, nutritional rehabilitation, and sometimes medication, with a focus on individualized goals for weekly weight gain and target weight, as recommended by the American Psychiatric Association in 2023 1. The most effective psychological treatment is considered to be cognitive-behavioral therapy (CBT), focusing on changing distorted thoughts about body image and eating. Family-based treatment (FBT or Maudsley approach) is particularly effective for adolescents, involving parents in the refeeding process. Some key points to consider in the treatment of anorexia include:

• Nutritional rehabilitation begins with careful refeeding to restore weight, typically aiming for 0.5-1 kg weight gain per week for inpatients and 0.2-0.5 kg for outpatients.
• Medications like olanzapine (2.5-10 mg daily) or fluoxetine (20-60 mg daily) may help with associated anxiety and depression, though no medication is FDA-approved specifically for anorexia.
• Medical monitoring is essential during treatment to manage complications like electrolyte imbalances and cardiac issues.
• Treatment often requires a team approach including psychiatrists, psychologists, dietitians, and medical doctors.
• Recovery takes time, with many patients needing treatment for at least 1-2 years, and some requiring higher levels of care like inpatient or residential treatment if outpatient therapy is insufficient or if medical complications arise. In terms of specific treatment options, the American Psychiatric Association recommends that patients with anorexia nervosa who require nutritional rehabilitation and weight restoration have individualized goals set for weekly weight gain and target weight 1. Additionally, corticosteroids may be considered to increase appetite in individuals with advanced disease for a restricted period of time, but with awareness of potential side effects 1. However, the use of cannabinoids is not recommended due to limited and inconsistent evidence 1.

From the FDA Drug Label

The effectiveness of dronabinol capsules has been established based on studies for the treatment of anorexia associated with weight loss in patients with AIDS and nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments. The appetite stimulant effect of dronabinol capsules in the treatment of AIDS-related anorexia associated with weight loss was studied in a randomized, double-blind, placebo-controlled study involving 139 patients. The initial dosage of dronabinol capsules in all patients was 5 mg/day, administered in doses of 2.5 mg one hour before lunch and one hour before dinner. A statistically significant difference between dronabinol capsules and placebo was seen in appetite as measured by the visual analog scale at weeks 4 and 6.

Tratamiento para la anorexia: El tratamiento para la anorexia asociada con pérdida de peso en pacientes con SIDA es con cápsulas de dronabinol.

• La dosis inicial es de 5 mg/día, administrada en dosis de 2,5 mg una hora antes del almuerzo y una hora antes de la cena.
• Se ha demostrado que el tratamiento con dronabinol mejora el apetito en pacientes con anorexia asociada con SIDA 2.

From the Research

Treatment for Anorexia

The treatment for anorexia involves a combination of nutritional, psychotherapeutic, and pharmacologic interventions.

• Medications such as megestrol acetate and dronabinol are commonly used to stimulate appetite in patients with anorexia 3.
• Dronabinol should be used for most anorectic patients, initially given in a low dose (2.5 mg) in the evening, and increased to 5 mg per day if no improvement in appetite is seen after 2 to 4 weeks 3.
• Megestrol acetate should be tried at a dose of 800 mg per day for no longer than 3 months, and should be administered with testosterone in men 3.
• Mirtazapine seems to be the antidepressant of choice in persons with depression and anorexia 3.
• The use of taste enhancers can be considered in persons who complain that the food does not taste good 3.

Pharmacologic Treatment

• Antidepressants are commonly used to treat bulimia nervosa, with high-dose fluoxetine being a standard approach 4.
• Binge eating disorder can be treated with antidepressants, medications that diminish appetite, or with lisdexamfetamine 4.
• Anorexia nervosa does not generally respond to medications, although recent evidence supports modest weight restoration benefits from olanzapine 4.
• Appetite-stimulating medications such as dronabinol, megestrol, and mirtazapine may show numerical improvements in meal intake in hospitalized patients 5.

Safety and Efficacy

• The safety and efficacy of appetite-stimulating medications in the inpatient setting have been evaluated, with no serious adverse effects observed 5.
• Almost half of the patients experienced improvement in diet after the start of medications 5.
• Centrally acting appetite suppressant drugs used in the treatment of obesity have been shown to reduce appetite and lower food intake, thereby helping obese patients more easily keep to a low-calorie diet and lose weight 6.
• Anorectic drugs which promote serotonin neurotransmission have no stimulant or sympathomimetic properties, and are effective in the treatment of obesity 6.

Limitations of Pharmacologic Treatments

• The core symptoms of anorexia nervosa are refractory to currently available psychotropic medication 7.
• Renutrition, psychotherapy, and family therapy remain the cornerstones of treatment for anorexia nervosa 7.
• Antidepressant medication may be useful for relapse prevention in anorexia nervosa 7.
• Placebo-controlled studies with antidepressant drugs have been more promising for treating bulimia nervosa in the short term 7.