What medications can increase appetite in individuals with anxiety-related decreased appetite?

Medications to Increase Appetite in Anxiety-Related Decreased Appetite

Mirtazapine is the most effective medication for increasing appetite in individuals with anxiety-related decreased appetite, with a recommended dosage of 15-30 mg daily. 1

First-Line Medication Options

Mirtazapine

• Mechanism: Acts as a noradrenergic and specific serotonergic antidepressant
• Dosage: 15-30 mg daily, typically taken at bedtime
• Benefits:
  • Potent appetite stimulation (reported in 17% of patients vs. 2% for placebo) 2
  • Weight gain (12% of patients gained ≥7% body weight vs. 2% for placebo) 2
  • Additional benefits for sleep difficulties and anxiety symptoms 1
  • Treats both the underlying anxiety and the appetite symptoms simultaneously

Cyproheptadine

• Dosage: 2-4 mg three times daily
• Benefits:
  • Well-established safety profile
  • Particularly effective in pediatric patients 1
  • Antihistamine properties help with anxiety symptoms

Second-Line Options

Megestrol Acetate

• Dosage: 160-800 mg/day
• Benefits:
  • Strong evidence for appetite stimulation in patients with weight loss
  • In clinical trials, 57-64% of patients gained ≥5 pounds (compared to 24% with placebo) 3
• Cautions:
  • Higher risk of thromboembolic events and fluid retention
  • Should be used for shorter periods when possible

Dexamethasone

• Dosage: 2-8 mg/day
• Benefits:
  • Provides rapid appetite stimulation
  • Effective for short-term use (1-3 weeks) 4
• Cautions:
  • Side effects include muscle wasting, insulin resistance, and increased infection risk
  • Not recommended for long-term use

Monitoring and Evaluation

1. Baseline Assessment:

   • Document current weight, BMI, and specific anxiety symptoms
   • Assess for comorbid conditions that might affect appetite (depression, gastrointestinal disorders)

2. Follow-up Evaluation:

   • Reassess appetite and weight after 2-4 weeks of therapy 1
   • Monitor for medication-specific side effects:
     • For mirtazapine: somnolence (54% vs. 18% placebo), dizziness (7% vs. 3% placebo) 2
     • For megestrol: fluid retention, thromboembolic events 3
     • For dexamethasone: hyperglycemia, muscle wasting 4

Important Clinical Considerations

1. Relationship Between Anxiety and Appetite:

   • Anxiety disorders are strongly associated with decreased appetite in up to 53% of patients 5
   • The connection appears bidirectional - treating anxiety often improves appetite and vice versa

2. Avoid Medications That Worsen Appetite:

   • Some anxiety medications (particularly stimulants and certain SSRIs) can further decrease appetite
   • Atomoxetine commonly causes decreased appetite as a side effect 6

3. Non-Pharmacological Approaches:

   • Implement alongside medication for best results:
     • Small, frequent meals (5-6 per day)
     • High-calorie, nutrient-dense foods
     • Creating a pleasant eating environment
     • Moderate physical activity when appropriate

Common Pitfalls to Avoid

1. Overlooking the underlying anxiety disorder:

   • Simply treating the appetite symptoms without addressing anxiety is likely to fail
   • Mirtazapine offers the advantage of treating both conditions simultaneously

2. Prolonged use of corticosteroids:

   • While effective for quick appetite stimulation, long-term use leads to significant side effects
   • Limit dexamethasone use to 1-3 weeks 4

3. Ignoring medication interactions:

   • Mirtazapine has potential interactions with MAOIs and other serotonergic drugs 2
   • Always review current medications before initiating appetite stimulants

4. Failing to monitor weight changes:

   • Regular weight monitoring is essential to assess effectiveness
   • Weight gain of >7% body weight requires evaluation of benefit vs. risk

By targeting both the anxiety and appetite symptoms simultaneously, mirtazapine offers the most balanced approach for patients with anxiety-related decreased appetite, with additional options available based on individual response and tolerability.