Pharmacotherapy of the eating disorders: a commentary

During the last 10 yr, evidence has accumulated which indicates that the eating disorders of bulimia and anorexia nervosa (BN and AN) may be differentially affected by pharmacological treatment. Although the efficacy of drug treatment alone (relative to nonpharmacological approaches) has been debated, there is support for the generalization that all types of antidepressant medications have proven efficacious for bulimia but not for anorexia. These clinical observations are consistent with an extensive body of research concerning the regulation of ingestion, which indicates that the neurotransmitter serotonin plays an important role in mediating satiety. Such considerations have led to the "serotonin-hypothesis of bulimia," which postulates that BN represents an underlying "hyposerotonergic" condition and, conversely, that AN represents a "hyperserotonergic" state. Recently, however, two independent studies have shown that the antidepressant fluoxetine, which selectively blocks the synaptic re-uptake of serotonin, provided significant therapeutic benefit for anorexic patients. The implications of these apparently anomalous results for the "serotonin-hypothesis of BN" are discussed in an attempt to gain insight into the present pharmacotherapy of the eating disorders.