37 - Psychopharmacology of eating disorders

Summary

Editor's note

Most people do not think much about drug treatment when eating disorders are mentioned. However, it has a long history, and 30–40 years ago drug treatments, particularly tricyclic antidepressants and typical antipsychotic drugs such as chlorpromazine, were regarded by many as essential treatments for anorexia nervosa (Dally & Sargant, 1966; Mills, 1976). A brief look at the evidence table tells us where we are today with these and other treatments, and shows the great turn-around of the last 20 years. The authors illustrate the difficulties in constructing an evidence base common to specialties in which numbers of patients are relatively few, but the results of this review are impressive, particularly in regard to bulimia nervosa, where there is now a solid range of effective treatments.

Introduction

The aim of this chapter is to synthesize the evidence from systematic reviews and various national clinical guidelines on the use of medication in the management of people with eating disorders and to set it in the context of clinical practice. A variety of National Guidelines for eating disorders have been published including those from the USA (American Psychiatric Association, 2000), UK (National Collaborating Centre for Mental Health, 2004), Australia and New Zealand (Beumont et al., 2004) and Finland (Ebeling et al., 2003). Most of these make some reference to the use of medication. Some of these guidelines (such as those from the UK and Australia) are built upon a systematic synthesis of all the evidence in the literature.