[Pharmacotherapy of eating disorders-An update]

Anorexia nervosa, bulimia nervosa and binge-eating disorder are severe mental illnesses and are often associated with mental comorbidities, such as depression, anxiety and obsessive-compulsive disorders. Psychotherapy is considered the primary method of treatment; however, in the clinical practice it is not uncommon to also use psychopharmacotherapy.

The article considers international and national guidelines as well as the updated World Federation of Societies of Biological Psychiatry (WFSBP) guidelines to summarize the current evidence on psychopharmacotherapy of eating disorders.

Anorexia nervosa: psychopharmacotherapy for anorexia nervosa should especially support weight gain. To date, there is no evidence for the efficacy of antidepressants for weight gain in anorexia nervosa. For antipsychotics, such as olanzapine in particular, the studies are heterogeneous, which is why off-label use in clinical practice is limited exclusively to individual cases. Bulimia nervosa: fluoxetine has been shown to be effective in reducing binge eating and compensatory behaviors. Fluoxetine is also the only medication approved in Germany for the treatment of an eating disorder. Binge-eating disorder: by far the greatest evidence exists for lisdexamfetamine. But this is not approved in Germany for the treatment of binge-eating disorder.

In recent years the number of randomized controlled trials on psychopharmacotherapy for eating disorders has greatly increased. In Germany, fluoxetine is still the only approved drug for the treatment of bulimia nervosa; however, psychopharmacotherapy for eating disorders should always be embedded in a treatment plan with psychotherapy and nutritional management as well as appropriate medical monitoring. Overall, there is a need for further research.