Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-19T00:22:25.644Z Has data issue: false hasContentIssue false

21 - Psychopharmacology and eating disorders

from Part IV - Evidence-based care

Published online by Cambridge University Press:  02 December 2009

Brett McDermott
By
Kristine J. Steffen ,
James L. Roerig  and
James E. Mitchell
Edited by
Tony Jaffa
Brett McDermott
Affiliation:
University of Queensland
Kristine J. Steffen
Affiliation:
Neuropsychiatric Research Institute, Fargo, ND, USA
James L. Roerig
Affiliation:
Neuropsychiatric Research Institute, Fargo, ND, USA
James E. Mitchell
Affiliation:
Neuropsychiatric Research Institute, Fargo, ND, USA
Tony Jaffa
Affiliation:
Phoenix Centre, Cambridge
Get access

Summary

Introduction

Pharmacological options for the treatment of anorexia nervosa (AN) and bulimia nervosa (BN) are sequentially reviewed within this chapter. Randomized, controlled medication trials represent the primary focus of discussion. The majority of pharmacotherapy research in AN and BN has been conducted with adult patients. Owing to potential pathophysiological or pharmacokinetic differences, it is unclear how results derived from these trials translate into the treatment of paediatric or adolescent patients.

Psychotropic use in children

Particularly when treating younger children, the prescriber is left with the task of designing age-specific dosage regimens. Pharmacokinetic parameters change markedly with age, including absorption, metabolism, distribution and elimination. Further, although the literature on pharmacodynamics is sparse in paediatrics, it is generally assumed that developmental changes influence drug action and response. For a discussion on these paediatric pharmacology issues, the reader is referred to a review by Kearns et al. (2003).

Antidepressants

Underweight patients have an increased risk of arrhythmia with tricyclic antidepressants (TCAs) (Kotler & Walsh, 2000) and an association between certain TCAs and sudden death in children has been identified. A 2001 review describes eight cases of sudden death in paediatric or adolescent patients, six of which involved desipramine monotherapy and two of which involved imipramine in combination therapy (Varley, 2001). As discussed in this report, desipramine may be more specifically toxic compared with other TCAs, and imipramine may be implicated because it is metabolized to desipramine.

Keywords

anorexia nervosabulimia nervosaeating disorderpharmacotherapypsychopharmacology
Type
Chapter
Information
Eating Disorders in Children and Adolescents , pp. 260 - 276
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agras, W. S. (1997). Pharmacotherapy of bulimia nervosa and binge eating disorder: longer-term outcomes. Psychopharmacology Bulletin, 33, 433–6.Google Scholar
Agras, W. S. (2001). The consequences and costs of the eating disorders. Psychiatric Clinics of North America, 24, 371–9.Google Scholar
Allison, D. B., Mentore, J. L., Heo, M.et al. (1999). Antipsychotic-induced weight gain: a comprehensive research synthesis. American Journal of Psychiatry, 156, 1686–96.Google Scholar
Allison, D. B. & Casey, D. E. (2001). Antipsychotic-induced weight gain: a review of the literature. Journal of Clinical Psychiatry, 62 (suppl. 7), 22–31.Google Scholar
American Academy of Child and Adolescent Psychiatry (AACAP) (2005). Summary of the Practice Parameter for the Assessment and Treatment of Children and Adolescents with Schizophrenia. www.aacap.org/clinical/schizo.htm.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM–N). Washington, DC: APA.
American Psychiatric Association (APA). Practice Guideline for the Treatment of Patients With Eating Disorders, 2nd edition. Accessed February 2005. http://www.psych.org/psych_pract/treatg/pg/eating_revisebook_index.cfm.
Attia, E., Haiman, C., Walsh, B. T. & Flater, S. R. (1998). Does fluoxetine augment the inpatient treatment of anorexia nervosa?American Journal of Psychiatry, 155, 548–51.Google Scholar
Bacaltchuk, J., Hay, P. & Trefiglior, R. (2003). Antidepressants versus psychological treatment and their combination for bulimia nervosa. In The Cochrane Library, 3, Cochrane Review.
Barbarich, N. C., Kaye, W. H. & Jimerson, D. (2003). Neurotransmitter and imaging studies. In Anorexia Nervosa: New Targets for Treatment. Current Drug Targets CNS Neurological Disorders, 2, 61–72.Google Scholar
Barbarich, N. C., McConaha, C. W., Gaskill, J.et al. (2004). An open trial of olanzapine in anorexia nervosa. Journal of Clinical Psychiatry, 65, 1480–2.Google Scholar
Biederman, J., Herzog, D. B., Rivinus, T. M.et al. (1985). Amitriptyline in the treatment of anorexia nervosa: a double-blind, placebo-controlled study. Journal of Clinical Psychopharmacology, 5, 10–16.Google Scholar
Birmingham, C. L., Goldner, E. M. & Bakan, R. (1994). Controlled trial of zinc supplementation in anorexia nervosa. International Journal of Eating Disorders, 15, 251–5.Google Scholar
Boachie, A., Goldfield, G. S. & Spettique, W. (2003). Olanzapine use as an adjunctive treatment for hospitalized children with anorexia nervosa: case reports. International Journal of Eating Disorders, 33, 98–103.Google Scholar
Carver, A. E., Miller, S., Hagman, J. & Sigel, E. (2002). The Use of Risperidone for the Treatment of Anorexia Nervosa. Academy of Eating Disorders Annual Meeting, Boston.
Faris, P. L., Kim, S. W., Meller, W. H.et al. (2000). Effect of decreasing afferent vagal activity with ondansetron on symptoms of bulimia nervosa; a randomized, double-blind trial. Lancet, 355, 792–7.Google Scholar
Fassino, S., Daga, G. A., Boggio, S., Garzaro, L. & Piero, A. (2004). Use of reboxetine in bulimia nervosa: a pilot study. Journal of Psychopharmacology, 18, 423–8.Google Scholar
US Food and Drug Administration (2004). Labeling Change Request Letter for Antidepressant Medications. www.fda.gov/cder/drug/antidepressants/SSRIlabelchange.html.
Fichter, M. M., Kruger, R., Rief, W., Holland, R. & Dohne, J. (1996). Fluvoxamine in prevention of relapse in bulimia nervosa: effects on eating-specific psychopathology. Journal of Clinical Psychopharmacology, 16, 9–18.Google Scholar
Fisman, S., Steele, M., Short, J., Byrne, T. & Lavallee, C. (1996). Case study: anorexia nervosa and autistic disorder in an adolescent girl. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 937–40.Google Scholar
Fluoxetine Bulimia Nervosa Collaborative Study Group (1992). Fluoxetine in the treatment of bulimia nervosa. Archives of General Psychiatry, 49, 139–47.
Garland, E. J., Remick, R. A. & Zis, A. P. (1988). Weight gain with antidepressants and lithium. Journal of Psychopharmacology, 8, 323–30.Google Scholar
Gaskill, J. A., Treat, T. A., McCabe, E. B. & Marcus, M. D. (2001). Does olanzapine affect the rate of weight gain among inpatients with eating disorders?Eating Disorders Review, 12, 1–2.Google Scholar
Goldstein, D. J., Wilson, M. G., Thompson, V. L.et al. (1995). Long-term fluoxetine treatment of bulimia nervosa. British Journal of Psychiatry, 166, 660–6.Google Scholar
Goldstein, D. J., Wilson, M. G., Ascroft, R. C. & al-Banna, M. (1999). Effectiveness of fluoxetine therapy in bulimia nervosa regardless of comorbid depression. International Journal of Eating Disorders, 25, 19–27.Google Scholar
Gross, H. A., Ebert, M. H., Faden, V. B.et al. (1981). A double-blind controlled trial of lithium carbonate primary anorexia nervosa. Journal of Clinical Psychopharmacology, 6, 376–81.Google Scholar
Halmi, K. A., Eckert, E., Ladu, T. J. & Cohen, J. (1986). Anorexia nerovsa: treatment efficacy of cyproheptadine and amitriptyline. Archives of General Psychiatry, 43, 177–81.Google Scholar
Hansen, L. (1999). Olanzapine in the treatment of anorexia nervosa. British Journal of Psychiatry, 175, 592.Google Scholar
Hoopes, S. P., Reimherr, F. W., Hedges, D. W.et al. (2003). Treatment of bulimia nervosa with topiramate in a randomized, double-blind, placebo-controlled trial, Part 1: Improvement in binge and purge measures. Journal of Clinical Psychiatry, 64, 1335–41.Google Scholar
Horne, R. L., Ferguson, J. M., Pope, H. G.et al. (1988). Treatment of bulimia with bupropion: a multicenter controlled trial. Journal of Clinical Psychiatry, 49, 262–6.Google Scholar
Jensen, V. S. & Mejlhede, A. (2000). Anorexia nervosa: treatment with olanzapine. British Journal of Psychiatry, 177, 187.Google Scholar
Katz, R. L., Keen, C. L., Litt, I. F.et al. (1987). Zinc deficiency in anorexia nervosa. Journal of Adolescent Health Care, 8, 400–6.Google Scholar
Kaye, W. H., Nagata, R., Weltzin, T. E.et al. (2001). Double-blind placebo-controlled administration of fluoxetine in restricting and purging-type anorexia nervosa. Biological Psychiatry, 49, 644–52.Google Scholar
Kearns, G., Abdel-Rahman, S., Alander, S.et al. (2003). Developmental pharmacology – drug disposition, action, and therapy in infants and children. New England Journal of Medicine, 349, 1157–67.Google Scholar
Kotler, L. A. & Walsh, B. T. (2000). Eating disorders in children and adolescents: pharmacological therapies. European Child and Adolescent Psychiatry, 9, I/108–16.Google Scholar
Kotler, L. A., Devlin, M. J., Davies, M. & Walsh, T. B. (2003). An open trial of fluoxetine for adolescents with bulimia nervosa. Journal of Child and Adolescent Psychopharmacology, 13, 329–35.Google Scholar
Lacey, J. H. & Crisp, A. H. (1980). Hunger, food intake and weight: the impact of clomipramine on a refeeding anorexia nervosa population. Postgraduate Medical Journal, 56 (suppl. 1), 79–85.Google Scholar
Via, M. C., Gray, L. & Kaye, W. H. (2000). Case reports of olanzapine treatment of anorexia nervosa. International Journal of Eating Disorders, 27, 363–6.Google Scholar
Mehler, C., Wewetzer, C., Schulze, U.et al. (2001). Olanzapine in children and adolescents with chronic anorexia nervosa. A study of five cases. European Child to Adolescent Psychiatry, 10, 151–7.Google Scholar
Melkersson, K. & Dahl, M. L. (2004). Adverse metabolic effects associated with atypical antipsychotics. Drugs, 64, 701–23.Google Scholar
Mitchell, J. E., Crow, S., Myers, T. & Wonderich, S. (2002). The therapeutic armamentarium in eating disorders. In Biological Psychiatry, ed. D'haenen, H., Boer, J. A. & Wilner, P.New York: John Wiley & Sons.
Nakash-Eisikovits, O., Dierberger, A. & Westen, D. (2002). A multidimensional meta-analysis of pharmacotherapy for bulimia nervosa: summarizing the range of outcomes in controlled clinical trials. Harvard Review of Psychiatry, 10, 193–211.Google Scholar
Newman-Toker, J. (2000). Risperidone in anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 941–2.Google Scholar
Pederson, K. J., Roerig, J. L. & Mitchell, J. E. (2003). Towards the pharmacotherapy of eating disorders. Expert Opinion on Pharmacotherapy, 4, 1659–78.Google Scholar
Powers, P. S., Santana, C. A. & Bannon, Y. S. (2002). Olanzapine in the treatment of anorexia nervosa: an open label trial. International Journal of Eating Disorders, 32, 146–54.Google Scholar
Powers, P. S. & Santana, C. (2004). Available pharmacological treatments for anorexia nervosa. Expert Opinion on Pharmacotherapy, 5, 2287–92.Google Scholar
Powers, P. S., Bannon, Y., Eubanks, R. & McCormick, T. (2004). Anorexia Nervosa and Quetiapine: Effect on Weight and Psychopathology. Poster presented at American Psychiatric Association meeting, New York, NY.Google Scholar
Roerig, J. L., Mitchell, J. E., Myers, T. C. & Glass, J. B. (2002). Pharmacotherapy and medical complications of eating disorders in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 11, 365–85, xi.Google Scholar
Romano, S. J., Halmi, K. A., Sarkar, N. P., Koke, S. C. & Lee, J. S. (2002). A placebo-controlled study of fluoxetine in continued treatment of bulimia nervosa after successful acute fluoxetine treatment. American Journal of Psychiatry, 159, 96–102.Google Scholar
Ruggiero, G. M., Laini, V., Mauri, M. C. (2001). A single blind comparison of amisulpride, fluoxetine and clomipramine in the treatment of restricting anorectics. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 25, 1049–59.Google Scholar
Sullivan, P.F. (1995). Mortality in anorexia nervosa. American Journal of Psychiatry, 152, 1073–4.Google Scholar
Sundblad, C., Landen, M., Eriksson, T., Bergman, L. & Eriksson, E. (2005). Effects of the androgen antagonist flutamide and the serotonin reuptake inhibitor citalopram in bulimia nervosa. Journal of Clinical Psychopharmacology, 25, 85–8.Google Scholar
Vandereycken, W. & Pierloot, R. (1982). Pimozide combined with behavior therapy in the short-term treatment of anorexia nervosa. Acta Psychiatrica Scandinavica, 66, 445–50.Google Scholar
Vandereycken, W. (1984). Neuroleptics in the short-term treatment of anorexia nervosa: a double-blind placebo-controlled study with sulpiride. British Journal of Psychiatry, 144, 288–92.Google Scholar
Varley, C. K. (2001). Sudden death related to selected tricyclic antidepressants in children: epidemiology, mechanisms, and clinical implications. Paediatrics and Drugs, 3, 613–27.Google Scholar
Walsh, B. T., Hadigan, C. M., Devlin, M. J.et al. (1991). Long-term outcome of antidepressant treatment for bulimia nervosa. American Journal of Psychiatry, 148, 1206–12.Google Scholar
Walsh, B. T., Kaplan, A. S., Attia, E.et al. (2006). Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. Journal of the American Medical Association, 295, 2605–12.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×