Antidepressants does not decrease risk of relapse in anorexia nervosa

Wed, 14 Jun 2006 19:41:37 PST

( from http://www.rxpgnews.com ) Use of the anti-depressant fluoxetine did not help patients with anorexia nervosa who had restored their body weight maintain that weight or reduce their risk of relapse, according to a study in the June 14 issue of JAMA.

Anorexia nervosa is an eating disorder primarily affecting young women and marked by an extreme fear of becoming overweight that leads to excessive dieting to the point of serious ill-health and sometimes death. It is a serious psychiatric illness with a lifetime death rate arguably as high as that associated with any psychiatric illness, according to background information in the article. A major contributor to the poor prognosis of this illness is the high rate of relapse, with 30 to 50 percent of patients requiring rehospitalization within 1 year of discharge after successful weight restoration. This has prompted interest in interventions aimed at preventing relapse following weight restoration. A substantial number of patients with anorexia nervosa receive antidepressant medications. Fluoxetine was initially marketed under the brand name of Prozac.

B. Timothy Walsh, M.D., of New York State Psychiatric Institute/Columbia University Medical Center, New York, and colleagues compared fluoxetine with placebo to determine the rate of relapse and behavioral recovery following initial treatment for anorexia nervosa. The trial included 93 patients with anorexia nervosa who had received intensive inpatient or day-program treatment and regained weight to a minimum body mass index (BMI) of 19.0. Participants were then randomly assigned to receive fluoxetine (n = 49) or placebo (n = 44) and were treated for up to 1 year as outpatients.

The researchers found that similar percentages of patients assigned to fluoxetine and to placebo maintained a BMI of at least 18.5 and remained in the study for 52 weeks (fluoxetine: 26.5 percent; placebo: 31.5 percent). The most conservative analysis of time-to-relapse found no significant difference between the fluoxetine and placebo groups in time-to-relapse. At 52 weeks, 45 percent of the placebo group and 43 percent of the fluoxetine group had not relapsed.

"The current study has implications for both clinical practice and research. The present findings, coupled with those of previously published studies, indicate that the common practice of prescribing antidepressant medication is unlikely to provide substantial benefit for most patients with anorexia nervosa, either when they are underweight or immediately upon weight restoration. These data imply that therapeutic efforts would be better devoted to psychological and behavioral interventions for which there is some, albeit modest, evidence of efficacy," the authors write. "Future research on the utility of novel psychological treatments and innovative psychotropic and nonpsychotropic medications is obviously needed."

In an accompanying editorial, Scott J. Crow, M.D., of the University of Minnesota, Minneapolis, comments on the findings of the study examining the use of fluoxetine for anorexia nervosa.

"The study by Walsh et al is an important contribution that addresses a major gap in research on anorexia nervosa and provides vital information about a fairly common treatment practice for this illness. Unfortunately, it appears that fluoxetine provides no benefit in the relapse prevention treatment of anorexia nervosa. Despite a prevalence rate similar to many other psychiatric illnesses, and particularly in light of the high mortality associated with anorexia nervosa, there is a serious underrepresentation of anorexia nervosa in biomedical research. Much more information is needed on the treatment of individuals with anorexia nervosa while they are at low weight. In addition, strategies must be developed to help individuals who recover to stay in recovery."

Bulimia-type anorexia nervosa shows increased serotonin binding

Tue, 06 Sep 2005 06:53:38 PST

( from http://www.rxpgnews.com ) Anorexia nervosa, a disorder characterized by the relentless pursuit of thinness and obsessive fear of being fat, has two subtypes, a group that restricts their eating (restricting-type AN) and a group that alternates restrictive eating with bulimic symptoms such as episodes of purging and/or binge eating (bulimia-type AN), according to background information in the article. Previous evidence has suggested that alterations in the activity of serotonin (a brain chemical involved in communication between nerve cells) may contribute to the appetite alteration in anorexia nervosa as well as playing a role in anxious, obsessional behaviors and extremes of impulse control.

Ursula F. Bailer, M.D., of the University of Pittsburgh School of Medicine, Pittsburgh, and colleagues compared the activity of serotonin in women who had recovered from each of the two types of anorexia nervosa and a control group of healthy women using positron emission tomography (PET). The researchers injected a molecule that can bind to a serotonin receptor in much the same way that serotonin does into specific areas of the women's brains and used PET scans to measure the extent of the molecule-receptor binding. This molecule-receptor binding served as a marker for alterations of serotonin neuronal activity. Thirteen women recovered from restricting-type AN, 12 women with bulimia-type AN and 18 healthy control women were included in the study.

The researchers report increased binding of this marker molecule in several brain regions in women who had recovered from bulimia-type AN but not restricting-type AN. Only the women who had recovered restricting-type AN showed any correlation between core eating disorder symptoms and binding potential. In these women receptor binding was correlated with a measure of anxiety called harm avoidance.

"In summary, this study lends further credibility to the possibility that women with AN have a persistent disturbance of 5-HT [serotonin] neuronal systems that may be related to increased anxiety," the authors conclude. "While it cannot be certain whether 5-HT alterations are a 'scar' following cessation of low weight and malnutrition, the fact that premorbid anxiety disorders occur in AN supports the possibility that altered 5-HT pathway function could predate the onset of AN and persist after recovery. There are no proven treatments for AN, and this illness has the highest mortality of any psychiatric disorder. These data offer the promise of a new understanding of the pathogenesis of AN and new drug and psychological treatment targets."

RxPG News : Anorexia Nervosa

Antidepressants does not decrease risk of relapse in anorexia nervosa

Bulimia-type anorexia nervosa shows increased serotonin binding