Anorexia not alleviated by anti-depressants

Patients battling to deal with the eating disorder anorexia nervosa, do not benefit or prevent relapses of the life-threatening eating disorder by taking the anti-depressant Prozac.

Anorexia nervosa is a serious life-threatening psychiatric illness with a high rate of relapse following initial treatment.

It appears to afflict mainly young women and is characterised by an extreme fear of becoming overweight which leads to excessive dieting, poor health and sometimes death.

Despite successful weight restoration, 30% to 50% of patients require re-hospitalization within 1 year of discharge.

Anorexia nervosa sufferers often show symptoms of other psychiatric disorders, such as depression and obsessive-compulsive disorder, which respond well to antidepressants which suggested to doctors that such medication might prove effective in treating the disorder.

However virtually all of the controlled trials of medication (most of which have been conducted during the initial phase of treatment when patients are underweight) have shown no benefit of medication compared with placebo.

Nevertheless as many as 60% of patients with anorexia nervosa substantial are treated with antidepressant medications such as Prozac.

Researchers at New York State Psychiatric Institute, Columbia University Medical Center, and the University of Toronto and Toronto General Hospital carried out a study involving 93 women with anorexia nervosa who were discharged after regaining a healthy weight.

Forty-nine patients were given fluoxetine and 44 a placebo and they received intensive inpatient or day-program treatment at the New York State Psychiatric Institute or Toronto General Hospital.

All patients also received individual cognitive behavioral therapy.

Dr. B. Timothy Walsh, chief author of the study, says they found that after a year there was no difference in the relapse rate between the two groups with over half of both groups again suffering the problem.

Dr. Walsh says the findings support evidence in previously published studies which indicate that 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.

The researchers say that therapy should focus on psychological and behavioral interventions for which there is some evidence of efficacy, rather than antidepressants and future research should focus on understanding the persistence of the illness and on exploring new psychological and pharmacological treatment approaches.

Prozac was developed by Eli Lilly and Co. but is now widely available as fluoxetine in generic versions since Lilly's patent has expired.

The report is published in the current edition of the Journal of the American Medical Association.