Advances in the Treatment of Anorexia Nervosa and Bulimia Nervosa

During the last decade, much investigation into possible pharmacotherapy for eating disorders has been undertaken, especially for bulimia nervosa.Intensive hospital treatment compromising a combination of individual, group and family therapies with or without adjunctive pharmacological treatments are usually offered in anorexia nervosa. Osteoporosis and delayed gastric emptying are 2 medical complications that should be addressed as early as possible in the course of the disorder. Although not yet confirmed in controlled clinical trials, there is preliminary support for the use of hormone replacement therapy for anorexic patients with amenorrhoea. The short term use of prokinetic agents such as cisapride or domperidone may assist in the refeeding process.Despite several controlled clinical trials involving antipsychotic and antidepressant drugs, there is no pharmacological agent that has demonstrated superiority in enhancing the rate of bodyweight gain. Recently, uncontrolled and unblinded trials with fluoxetine in anorexia nervosa have offered promising results. However, further double-blind controlled evaluation is necessary to properly evaluate the role of fluoxetine or other selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) in treating anorexia nervosa.In contrast to the limited literature on the treatment of anorexia nervosa, there have been a series of controlled clinical trials investigating treatments for bulimia nervosa. These have involving different forms of psychotherapy, both individual and group formats, or pharmacotherapy. Several investigators have also reported on the benefits of combining drug and psychological treatment in comparison to either approach on its own.SSRIs, monoamine oxidase inhibitors and tricyclic antidepressants have all been shown to offer symptomatic improvement in trials lasting between 6 and 24 weeks. A 24-week clinical trial of desipramine combined with individual cognitive therapy produced the best outcome.It is hoped that over time, with reduced cultural pressures to diet and with more emphasis on early detection of those individuals at risk of developing eating disorders, the occurrence and complications of these disorders will be reduced. Treatment research in the next decade will hopefully include clinical and biological predictors of response, meaningful long term outcome assessment, and novel interventions that will minimise the significant morbidity and mortality of these illnesses.