Healthy Skepticism Library item: 5186

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Publication type: news

Carey B.
Study Sees No Gain in Using Antidepressant to Treat Anorexia
New York Times 2006 Jun 14
http://www.nytimes.com/2006/06/14/health/14prozac.html?_r=1&oref=slogin

Notes:

Ralph Faggotter’s Comments:

For years we have been told that SSRIs are useful in the treatment of anorexia nervosa.

It looks like this was just another pharmaco-therapeutic myth.

Full text:

Study Sees No Gain in Using Antidepressant to Treat Anorexia
By BENEDICT CAREY
Published: June 14, 2006

One of the most widely used treatments for the eating disorder anorexia
nervosa, the antidepressant Prozac, works no better than dummy pills in
preventing recurrence in young women who have recovered from it, researchers
are reporting today.

Fluoxetine After Weight Restoration in Anorexia Nervosa (JAMA) The study,
the most rigorous to date to test the use of medication for anorexia, should
alter treatment for an illness that is often devastatingly chronic and that
has a higher mortality than any other psychiatric disorder, experts said.
Fewer than a third of the study’s participants, who also received regular
psychotherapy, remained healthy for a year or more, whether they received
drug treatment or not, the study found.

An estimated 1 percent of Americans, or about three million people, mostly
young women, will at some point suffer from the self-starvation and
obsessive anxiety about weight that characterize anorexia, and surveys find
that about two-thirds of them receive treatment with Prozac or similar
antidepressants, which are considered generally interchangeable.

Research suggests that the drugs can be useful in helping people recover
from bulimia nervosa, an eating disorder involving bingeing and purging
that causes less dramatic weight loss than anorexia. But the new findings
put to rest hopes from earlier work that these benefits might carry over to
anorexia, experts said.

“Physicians who are trying to help people with anorexia remain symptom-free
should not count on getting substantial benefits from antidepressants,” said
Dr. B. Timothy Walsh, the lead author of the study, who is director of
eating disorders research at the New York State Psychiatric Institute at the
Columbia University Medical Center

“Doctors should be looking at other things, like good psychological
treatments,” Dr. Walsh said.

In the study, appearing in The Journal of the American Medical Association,
researchers from Columbia and the University of Toronto monitored 93 women,
ages 16 to 45, who, after receiving intensive psychotherapy, gained enough
weight to fall into the normal range. Half the group then received daily
doses of Prozac, and the other half took dummy pills. All of them continued
in weekly psychotherapy, where they practiced techniques to examine and
diffuse irrational assumptions about weight and body image.

After a year, 26 percent of those on Prozac and 31 percent of those taking
placebo pills remained in a healthy weight range, the study found. The
differences between the two groups, in weight and on measures of beliefs
about food and weight gain, were not large enough to be significant.

“This study will change practice, beginning with the community of doctors
who specialize in eating disorders and spreading more broadly” to other
doctors, said Dr. Scott Crow, a psychiatrist at the University of Minnesota
, who wrote an editorial accompanying the study.

Dr. Walter Kaye, a professor of psychiatry at the University of Pittsburgh
said the new findings should not rule out the use of antidepressant
treatment altogether. In 2001, Dr. Kaye published a small study suggesting
that Prozac did help some young women who had recovered from anorexia keep
on weight. They were women who did not binge – they ate very little – and
did not receive psychotherapy.

“For patients like these, who don’t have access to psychological treatments,
who have a choice between medication or nothing at all, I think the
medication could help,” Dr. Kaye said.

All agree that the new findings emphasize the importance of thinking
creatively about treatment. The best psychotherapy available, said Dr. Crow,
helps only about a third of anorexia patients recover. Another third learn
to moderate and live with their aversions to food, while the rest develop a
chronic disorder, putting them at high risk for suicide or death from
starvation.

Researchers are experimenting with several new therapeutic techniques. One
is a type of family therapy for adolescents, in which parents take charge of
all meals. The parents decide how much their daughter or son should eat – based on specific guidelines – and reward good behavior, if appropriate.
Several studies suggest that this approach can lead to sustained recovery in
some teenagers. Some evidence suggests that this kind of close monitoring by
a therapist can also help adults with the disorder.

Psychiatrists have experimented, so far in vain, with a wide variety of
drugs for treatment, including antipsychotic medications, so-called
mood-stabilizing drugs like lithium and agents similar to the active
ingredients in marijuana.

“It’s disappointing, really,” Dr. Walsh said. “We would like to do better.
We need to do better.”