From the Guidelines
Pharmacotherapy for pica should be guided by the underlying cause, with selective serotonin reuptake inhibitors (SSRIs) being a potential treatment option, although the provided evidence does not directly address pica treatment. When considering treatment for pica, it's essential to evaluate the patient's overall condition, including any comorbid psychiatric or nutritional deficiencies.
- The American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1 provides recommendations for various eating disorders but does not specifically address pica.
- However, the guideline emphasizes the importance of a comprehensive, culturally appropriate, and person-centered treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise for patients with eating disorders.
- While the guideline recommends SSRIs, such as fluoxetine, for bulimia nervosa 1, it is crucial to consider that pica may have different underlying causes, including nutritional deficiencies or developmental disorders.
- In clinical practice, pharmacotherapy for pica may involve SSRIs, such as fluoxetine (20-80 mg daily) or sertraline (50-200 mg daily), as well as other medications like iron supplementation for iron deficiency-related pica or atypical antipsychotics for pica associated with developmental disorders.
- A tailored approach, combining medication with behavioral therapy and regular monitoring for side effects and underlying condition improvement, is essential for optimal outcomes in treating pica.
- It is also important to note that the treatment duration and specific medication regimen should be individualized based on the patient's response and underlying cause of pica.
From the Research
Pharmacotherapy for Pica
- There is limited evidence for the use of pharmacotherapy in the treatment of pica, as stated in the study 2.
- Some studies have reported benefits from the use of selective serotonin reuptake inhibitors (SSRIs), atypical antipsychotics, and methylphenidate, although the evidence is largely flimsy 2.
- SSRIs, such as fluoxetine and paroxetine, are commonly used to treat obsessive-compulsive disorder (OCD) and other conditions, and may be considered for the treatment of pica due to their effects on serotonin levels 3, 4, 5.
- The effectiveness of SSRIs for the treatment of OCD in adolescents and children has been demonstrated in several studies, with fluoxetine and sertraline appearing to be superior to fluvoxamine 6.
- Fluvoxamine has been shown to be effective in the treatment of OCD, with a large database of studies demonstrating its efficacy and tolerability 5.
- The use of SSRIs, including fluoxetine, has been associated with a range of side effects, including gastrointestinal symptoms, neurological symptoms, and psychiatric symptoms 3, 4, 5.