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Chapter 47. Psychopharmacological Treatment

James E. Mitchell, M.D.; Scott J. Crow, M.D.
DOI: 10.1176/appi.books.9781585622986.261987

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In parallel with the development of various pharmacological strategies for the treatment of other psychiatric disorders over the last few decades, considerable research has focused on the development of drug treatments as both primary and ancillary interventions in the treatment of clinical eating disorders. As we will see, the literature on anorexia nervosa is, at this point, still quite limited for several reasons. First, anorexia nervosa is a relatively rare condition. Second, individuals with anorexia nervosa usually are quite ill and require multiple interventions, often including in-hospital treatment, medical management, and psychotherapy. Therefore, the complexity of treatment designs makes it very difficult to design pharmacological trials for this population. Third, patients with anorexia nervosa are not particularly insightful about their illness and are frequently hesitant to participate in randomized treatment trials. Therefore, as will be seen, the results of studies thus far in anorexia nervosa are for the most part inconclusive, although some interesting findings have surfaced in the available studies that are important to clinical practice.

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References

Agras WS, Dorian B, Kirkley BG, et al: Imipramine in the treatment of bulimia: a double-blind controlled study. Int J Eat Disord 6:29–38, 1987
 
Agras WS, Rossiter EM, Arnow B, et al: Pharmacological and cognitive-behavioral treatment for bulimia nervosa: a controlled comparison. Am J Psychiatry 149:82–87, 1992
[PubMed]
 
Alger A, Schwalberg MD, Bigaouette JM, et al: Effect of a tricyclic antidepressant and opiate antagonist on binge eating behavior in normoweight bulimic and obese, binge eating subjects. Am J Clin Nutr 53:865–871, 1991
[PubMed]
 
Alger SA, Malone M, Cerulli J, et al: Beneficial effects of pharmacotherapy on weight loss, depressive symptoms, and eating patterns in obese binge eaters and non-binge eaters. Obes Res 7:469–476, 1999
[PubMed]
 
Appolinario JC, Bacaltchuk J, Sichieri R, et al: A randomized, double-blind, placebo-controlled study of sibutramine in the treatment of binge-eating disorder. Arch Gen Psychiatry 60:1109–1116, 2003
[PubMed]
 
Arnold LM, McElroy SL, Hudson JI, et al: A placebo-controlled, randomized trial of fluoxetine in the treatment of binge-eating disorder. J Clin Psychiatry 63:1028–1033, 2002
[PubMed]
 
Attia E, Haiman C, Walsh BT, et al: Does fluoxetine augment the inpatient treatment of anorexia nervosa? Am J Psychiatry 155:548–551, 1998
[PubMed]
 
Bacaltchuk J, Hay P: Antidepressants versus placebo for people with bulimia nervosa. Cochrane Database Syst Rev (4):CD003391, 2003
 
Barbarich NC, McConaha CW, Gaskill J, et al: An open trial of olanzapine in anorexia nervosa. J Clin Psychiatry 65:1480–1482, 2004
[PubMed]
 
Barlow J, Blouin J, Blouin A, et al: Treatment of bulimia with desipramine: a double-blind crossover study. Can J Psychiatry 33:129–133, 1988
[PubMed]
 
Biederman J, Herzog DB, Rivinus TM, et al: Amitriptyline in the treatment of anorexia nervosa: a double-blind, placebo-controlled study. J Clin Psychopharmacol 5:10–16, 1985
[PubMed]
 
Birmingham CL, Goldner EM, Balan R: Controlled trial of zinc supplementation in anorexia nervosa. Int J Eat Disord 15:251–255, 1994
[PubMed]
 
Blouin AG, Blouin JH, Perez EL, et al: Treatment of bulimia with fenfluramine and desipramine. J Clin Psychopharmacol 8:261–269, 1988
[PubMed]
 
Carruba MO, Cuzzolaro M, Riva L, et al: Efficacy and tolerability of moclobemide in bulimia nervosa: a placebo-controlled trial. Int Clin Psychopharmacol 16:27–32, 2001
[PubMed]
 
Casper RC, Schlemmer RJ Jr, Javaid JI: A placebo-controlled crossover study of oral clonidine in acute anorexia nervosa. Psychiatry Res 20:249–260, 1987
[PubMed]
 
Faris PK, Kim SW, Meller WH, et al: Effect of decreasing afferent vagal activity with ondansetron on symptoms of bulimia nervosa: a randomized, double-blind trial. Lancet 355:792–797, 2000
[PubMed]
 
Fichter MM, Leibl K, Rief W, et al: Fluoxetine versus placebo: a double-blind study with bulimic inpatients undergoing intensive psychotherapy. Pharmacopsychiatry 24:1–7, 1991
[PubMed]
 
Fichter MM, Kruger R, Rief W, et al: Fluvoxamine in prevention of relapse in bulimia nervosa: effects on eating-specific psychopathology. J Clin Psychopharmacol 15:9–18, 1996
 
Fluoxetine Bulimia Nervosa Collaborative Study Group: Fluoxetine in the treatment of bulimia nervosa: a multicenter, placebo-controlled, double-blind trial. Arch Gen Psychiatry 49:139–147, 1992
 
Goldberg SC, Halmi KA, Eckert ED, et al: Cyproheptadine in anorexia nervosa. Br J Psychiatry 123:67–70, 1979
 
Goldbloom D, Olmsted M, Davis R, et al: A randomized controlled trial of fluoxetine and individual cognitive behavioral therapy for women with bulimia nervosa: short-term outcome. Behav Res Ther 35:803–811, 1997
[PubMed]
 
Golden NH, Lanzkowsky L, Schebendach J, et al: The effect of estrogen-progestin treatment on bone-mineral density in anorexia nervosa. J Pediatr Adolesc Gynecol 15:135–143, 2002
[PubMed]
 
Goldstein DJ, Wilson MG, Thompson VL, et al: Long-term fluoxetine treatment of bulimia nervosa. Fluoxetine Bulimia Nervosa Research Group. Br J Psychiatry 166:660–666, 1995
[PubMed]
 
Goldstein DJ, Wilson MG, Ascroft RC, et al: Effectiveness of fluoxetine therapy in bulimia nervosa regardless of comorbid depression. Int J Eat Disord 25:19–27, 1999
[PubMed]
 
Gordon CM, Grace E, Emans SJ, et al: Effects of oral dehydroepiandrosterone on bone density in young women with anorexia nervosa: a randomized trial. J Clin Endocrinol Metab 87:4935–4941, 2002
[PubMed]
 
Grilo CM, Masheb RM, Wilson GT: Efficacy of cognitive behavioral therapy and fluoxetine for the treatment of binge eating disorder: a randomized double-blind placebo-controlled comparison. Biol Psychiatry 57:301–309, 2005
[PubMed]
 
Grinspoon S, Thomas L, Miller K, et al: Effects of recombinant human IGF-I and oral contraceptive administration on bone density in anorexia nervosa. J Clin Endocrinol Metab 87:2883–2891, 2002
[PubMed]
 
Gross HA, Ebert MH, Faden VB, et al: A double-blind controlled trial of lithium carbonate in primary anorexia nervosa. J Clin Psychopharmacol 1(6):376–381, 1981
[PubMed]
 
Gross HA, Ebert MH, Faden VB, et al: a double-blind trial of D9-tetrahydrocannabinol in primary anorexia nervosa. J Clin Psychopharmacol 3:165–171, 1983
[PubMed]
 
Gwirtsman HE, Guze BH, Yager J, et al: Fluoxetine treatment of anorexia nervosa: an open clinical trial. J Clin Psychiatry 51:378–382, 1990
[PubMed]
 
Halmi KA, Eckert E, LaDu TJ, et al: Anorexia nervosa: treatment efficacy of cyproheptadine and amitriptyline. Arch Gen Psychiatry 43:177–181, 1986
[PubMed]
 
Hansen L: Olanzapine in the treatment of anorexia nervosa. Br J Psychiatry 175:592, 1999
[PubMed]
 
Horne RE, Fergusen JM, Pope HG, et al: Treatment of bulimia with bupropion: a multicenter controlled trial. J Clin Psychiatry 42:261–266, 1988
 
Hsu LK: Treatment of bulimia with lithium. Am J Psychiatry 141:160–162, 1984
 
Hsu LK, Clement L, Stanthouse R, et al: Treatment of bulimia nervosa with lithium carbonate: a controlled study. J Nerv Ment Dis 179:351–355, 1991
[PubMed]
 
Hudson JI, McElroy SL, Raymond NC, et al: Fluvoxamine in the treatment of binge-eating disorder: a multicenter placebo-controlled, double-blind trial. Am J Psychiatry 155:1756–1762, 1998
[PubMed]
 
Hughes PK, Wells LA, Cunningham CJ, et al: Treatment of bulimia with desipramine. Arch Gen Psychiatry 43:182–186, 1986
[PubMed]
 
Iketani T, Kiriike N, Murry BS, et al: Effect of menatetrenone (vitamin K2) treatment on bone loss in patients with anorexia nervosa. Psychiatry Res 117:259–269, 2003
[PubMed]
 
Igoin-Apfelbaum L, Apfelbaum M: Naltrexone and bulimic symptoms (letter). Lancet 2(8567):1087–1088, 1987
[PubMed]
 
Jonas JM, Gold MS: The use of opiate antagonists in treating bulimia: a study of low-dose versus high-dose naltrexone. Psychiatry 52:464–471, 1991
 
Kaplan AS, Garfinkel PE, Darby P, et al: Carbamazepine in the treatment of bulimia. Am J Psychiatry 140:1225–1226, 1983
[PubMed]
 
Kaye WH, Weltzin TE, Hsu LKG, et al: An open trial of fluoxetine in patients with anorexia nervosa. J Clin Psychiatry 52:464–471, 1991
[PubMed]
 
Kaye WH, Nagata T, Weltzin TE, et al: Double-blind placebo-controlled administration of fluoxetine in restricting and purging-type anorexia nervosa. Biol Psychiatry 49:644–652, 2001
[PubMed]
 
Kennedy SH, Piran N, Warsh JJ, et al: A trial of isocarboxazid in the treatment of bulimia nervosa. J Clin Psychopharmacol 8:391–396, 1988
[PubMed]
 
Kotler LA, Devlin MH, Davies M, et al: An open trial of fluoxetine for adolescents with bulimia nervosa. J Child Adolesc Psychopharmacol 13:329–335, 2003
[PubMed]
 
Lacey JH, Crisp AH: Hunger, food intake and weight: the impact of clomipramine on a refeeding anorexia nervosa population. Postgrad Med J 56 (suppl 1):79–85, 1980
 
Laederach-Hofmann K, Graf C, Horber F, et al: Imipramine and diet counseling with psychological support in the treatment of obese binge eaters: a randomized, placebo-controlled double-blind study. Int J Eat Disord 26:231–244, 1999
[PubMed]
 
Leitenberg J, Rosen JC, Wolf J, et al: Comparison of cognitive-behavior therapy and desipramine in the treatment of bulimia nervosa. Behav Res Ther 32:37–46, 1994
[PubMed]
 
Malina A, Gaskill J, McConaha C, et al: Olanzapine treatment of anorexia nervosa: a retrospective study. Int J Eat Disord 33:234–237, 2003
[PubMed]
 
Marcus MD, Wing RR, Ewing L, et al: A double-blind, placebo-controlled trial of fluoxetine plus behavior modification in the treatment of obese binge-eaters and non-binge-eaters. Am J Psychiatry 147:876–881, 1990
[PubMed]
 
McCann UD, Agras WS: Successful treatment of nonpurging bulimia nervosa with desipramine: a double-blind, placebo-controlled study. Am J Psychiatry 147:1509–1513, 1990
[PubMed]
 
McElroy SL, Casuto LS, Nelson EB, et al: Placebo-controlled trial of sertraline in the treatment of binge eating disorder. Am J Psychiatry 157:1004–1006, 2000
[PubMed]
 
McElroy SL, Arnold LM, Shapira NA, et al: Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial. Am J Psychiatry 160:255–261, 2003
[PubMed]
 
Mehler C, Wewetzer C, Schulze U, et al: Olanzapine in children and adolescents with chronic anorexia nervosa: a study of five cases. Eur Child Adolesc Psychiatry 10:151–157, 2001
[PubMed]
 
Mitchell JE, Groat R: A placebo-controlled, double-blind trial of amitriptyline in bulimia. J Clin Psychopharmacol 4:186–193, 1984
[PubMed]
 
Mitchell JE, Laine DE, Morley JE, et al: Naltrexone but not CCK-8 may attenuate binge eating behavior in patients with bulimia syndrome. Biol Psychiatry 21:1399–1406, 1986
[PubMed]
 
Mitchell JE, Christenson G, Jennings J, et al: A placebo-controlled, double-blind crossover study of naltrexone hydrochloride in patients with normal weight bulimia. J Clin Psychopharmacol 9:94–97, 1989
[PubMed]
 
Mitchell JE, Pyle RL, Eckert ED, et al: A comparison study of antidepressants and structured intensive group psychotherapy in the treatment of bulimia nervosa. Arch Gen Psychiatry 47:149–157, 1990
[PubMed]
 
Mitchell JE, Halmi K, Wilson GT, et al: A randomized secondary treatment study of women with bulimia nervosa who fail to respond to CBT. Int J Eat Disord 32:271–281, 2002
[PubMed]
 
Munoz MT, Morand G, Garci-Centenera JA, et al: The effects of estrogen administration on bone mineral density in adolescents with anorexia nervosa. Eur J Endocrinol 146:45–50, 2002
[PubMed]
 
Nakahara T, Nagai N, Tanaka M, et al: The effects of bone therapy on tibial bone loss in young women with anorexia nervosa. Int J Eat Disord 39:20–26, 2006
[PubMed]
 
Pope HG Jr, Hudson JI, Jonas JM, et al: Bulimia treated with imipramine: a placebo-controlled, double-blind study. Am J Psychiatry 140:554–558, 1983
[PubMed]
 
Pope HG Jr, Kreek PE, McElroy SL, et al: A placebo-controlled study of trazodone in bulimia nervosa. J Clin Psychopharmacol 9:254–259, 1989
[PubMed]
 
Powers PS, Santana CA, Bannon YS: Olanzapine in the treatment of anorexia nervosa: an open label trial. Int J Eat Disord 32:146–154, 2002
[PubMed]
 
Romano SJ, Halmi KA, Sarkar NP, et al: A placebo-controlled study of fluoxetine in continued treatment of bulimia nervosa after successful acute fluoxetine treatment. Am J Psychiatry 159:96–102, 2002
[PubMed]
 
Russell GFM: Bulimia nervosa: an ominous variant of anorexia nervosa. Psychol Med 9:429–448, 1979
[PubMed]
 
Russell GFM, Checkley SA, Feldman J, et al: A controlled trial of d-fenfluramine in bulimia nervosa. Clin Neuropharmacol 11 (suppl 1):S146–S159, 1988
 
Sabine EJ, Yonace A, Farrington AJ, et al: Bulimia nervosa: a placebo-controlled, double-blind therapeutic trial of mianserin. Br J Clin Pharmacol 15 (suppl 2):S195–S202, 1983
 
Schmidt U, Cooper PJ, Essers H, et al: Fluvoxamine and graded psychotherapy in the treatment of bulimia nervosa: a randomized, double-blind, placebo-controlled, multicenter study of short-term and long-term psychotherapy combined with a stepped care approach to psychotherapy. J Clin Psychopharmacol 24:549–552, 2004
[PubMed]
 
Stacher G, Abatzi-Wenzel TA, Wiesnagrotzki S, et al: Gastric emptying, body weight and symptoms in primary anorexia nervosa: long-term effects of cisapride. Br J Psychiatry 162:398–402, 1993
[PubMed]
 
Strober M, Freeman R, DeAntonio M, et al: Does adjunctive fluoxetine influence the post-hospital course of anorexia nervosa? A 24-month prospective, longitudinal follow-up and comparison with historical control. Psychopharmacol Bull 33:425–4431, 1997
[PubMed]
 
Stunkard A, Berkowitz R, Tanrikut C, et al: d-Fenfluramine treatment of binge eating disorder. Am J Psychiatry 153: 1455–1459, 1996
[PubMed]
 
Szmukler GI, Young GP, Miller G, et al: A controlled trial of cisapride in anorexia nervosa. Int J Eat Disord 17:347–357, 1995
[PubMed]
 
Vandereycken W: Neuroleptics in the short-term treatment of anorexia nervosa: a double-blind placebo-controlled study with sulpiride. Br J Psychiatry 144:288–292, 1984
[PubMed]
 
Vandereycken W, Pierloot R: Pimozide combined with behavior therapy in the short-term treatment of anorexia nervosa: a double-blind placebo-controlled cross-over study. Acta Psychiatr Scand 66:445–450, 1982
[PubMed]
 
Vigersky RA, Loriaux DL: The effect of cyproheptadine in anorexia nervosa: a double-blind trial, in Anorexia Nervosa. Edited by Vigersky RA. New York, Raven, 1977, pp 131–139
 
Walsh BT, Gladis M, Roose SP, et al: Phenelzine vs placebo in 50 patients with bulimia. Arch Gen Psychiatry 45:471–475, 1988
[PubMed]
 
Walsh BT, Hadigan CM, Devlin MH, et al: Long-term outcome of antidepressant treatment for bulimia nervosa. Am J Psychiatry 148:1206–1212, 1991
[PubMed]
 
Walsh BT, Wilson GT, Loeb KL, et al: Medication and psychotherapy in the treatment of bulimia nervosa. Am J Psychiatry 154:523–531, 1997
[PubMed]
 
Walsh BT, Agras WS, Devlin MJ, et al: Fluoxetine for bulimia nervosa following poor response to psychotherapy. Am J Psychiatry 157:1332–1334, 2000
[PubMed]
 
Walsh BT, Kaplan AS, Attia E, et al: Fluoxetine vs placebo to prevent relapse following weight restoration in anorexia nervosa. Symposium 1: New Research on the Pharmacotherapy for Anorexia Nervosa. Eating Disorder Research Society, 11th Annual Meeting, Toronto, ON, Canada, September 29, 2005
 
Wermuth BM, Davis KL, Hollister LE, et al: Phenytoin treatment of the binge-eating syndrome. Am J Psychiatry 134:1249–1253, 1977
[PubMed]
 
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