Pharmacotherapy of Eating Disorders

The evidence for pharmacotherapy of anorexia nervosa (AN) is overall unsatisfactory for both antidepressants and antipsychotics (AWMF 2018). The primary outcome criteria were primarily weight criteria: extent of weight gain, rate of weight gain, duration of treatment until weight restoration, and number of patients who achieved adequate weight gain. Only a few studies had longer follow-up periods, which are necessary to assess the clinical significance of weight effects under pharmacotherapy. The available controlled trials on the use of tricyclic antidepressants (TCA) showed no significant efficacy on weight gain and depressive mood compared to placebo. Selective serotonin reuptake inhibitors (SSRIs) have also proven to be ineffective and are not likely to support weight gain (de Vos et al. 2014). Retrospective studies confirm this negative result for adolescents as well. SSRIs are often used in clinical practice in combination with psychotherapy for patients with AN, as an effect on comorbid disorders such as depression, anxiety, obesessive-compulsive symptoms, or bulimic symptoms is expected. However, it has been reported that antidepressants have little to no effect on comorbid symptoms in many patients in the underweight state. A low efficacy of antidepressants in the state of starvation can be assumed (Jordan et al. 2008). Comorbid disorders can improve solely through weight gain without additional specific therapy, so decisions about adjuvant pharmacotherapy should be made after weight gain. If depressive symptoms persist after adequate weight rehabilitation, additional treatment with SSRIs should be considered.