Skip to main content Accessibility help
×
Home
  • Print publication year: 2012
  • Online publication date: August 2012

10 - Evidence-based pharmacotherapy of eating disorders

Summary

Bipolar disorder is commonly accompanied by substantial comorbidity, including high rates of anxiety disorders and also of substance and alcohol-use disorders. This chapter considers evidence-based pharmacotherapy for the three main clinical scenarios-episodes of bipolar depression, manic or mixed episodes, and the prevention of relapse. In new episodes of bipolar depression, the three approaches with the strongest evidence base at present are the use of quetiapine, lamotrigine, and the optimization of existing long-term treatments. The evidence for the use of conventional antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), in bipolar depression has weakened in recent years. Studies in bipolar disorder have for the most part employed valproate in the form of divalproex. A recentmeta-analysis identified four small randomized placebo-controlled trials of valproate in bipolar I or bipolar II depression. Strong evidence guides first-line choices for episodes of bipolar depression, manic or mixed episodes, and for relapse prevention.

Related content

Powered by UNSILO

References

Allison KC, Lundgren JD, O’Reardon JP et al. (2010). Proposed diagnostic criteria for night eating syndrome. International Journal of Eating Disorders 43, 241–247.
American Psychiatric Association (APA) (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.
American Psychiatric Association (APA) (2006). Practice guideline for the treatment of patients with eating disorders (American Psychiatric Association). American Journal of Psychiatry 157, 1–39.
Appolinario JC, Bacaltchuk J, Sichieri R et al. (2003). A randomized, double-blind, placebo-controlled study of sibutramine in the treatment of binge-eating disorder. Archives of General Psychiatry 60, 1109–1116.
Arnold LM, McElroy SL, Hudson JI et al. (2002). A placebo-controlled, randomized trial of fluoxetine in the treatment of binge-eating disorder. Journal of Clinical Psychiatry 63, 1028–1033.
Arterburn DE, Crane PK, Veenstra DL (2004). The efficacy and safety of sibutramine for weight loss: a systematic review. Archives of Internal Medicine 164, 994–1003.
Attia E, Haiman C, Walsh BT (1998). Does fluoxetine augment the inpatient treatment of anorexia nervosa? American Journal of Psychiatry 155, 144–151.
Bacaltchuk J, Hay P (2003). Antidepressants vs. placebo for people with bulimia nervosa. Cochrane Database of Systematic Reviews 4, CD003391.
Bacaltchuk J, Trefiglio RP, Oliveira IR et al. (2000). Combination of antidepressants and psychological treatments for bulimia nervosa: a systematic review. Acta Psychiatrica Scandinavica 101, 256–264.
Baranowska B, Rozbicka G, Jeske W, Abdel-Fattah MH (1984). The role of endogenous opiates in the mechanism of inhibited luteinizing hormone (LH) secretion in women with anorexia nervosa: the effect of endorphin secretion. Journal of Clinical Endocrinology and Metabolism 59, 412–416.
Barbarich NC, McConaha CW, Gaskill J et al. (2004 a). An open trial of olanzapine in anorexia nervosa. Journal of Clinical Psychiatry 65, 1480–1482.
Barbarich NC, McConaha CW, Halmi KA et al. (2004 b). Use of nutritional supplements to increase the efficacy of fluoxetine in the treatment of anorexia nervosa. International Journal of Eating Disorders 35, 10–15.
Biederman J, Herzog DB, Rivinus TM et al. (1985). Amitriptyline in the treatment of anorexia nervosa: a double-blind, placebo-controlled study. Journal of Clinical Psychopharmacology 5, 10–16.
Birmingham CL, Goldner EM, Bakan R (1994). Controlled trial of zinc supplementation in anorexia nervosa. International Journal of Eating Disorders 15, 251–255.
Bissada H, Tasca G, Barber AM, Bradwejn J (2008). Olanzapine in the treatment of low body weight and obsessive thinking in women with anorexia nervosa: a randomized, double-blind, placebo-controlled trial. American Journal of Psychiatry 165, 1281–1288.
Boachie A, Goldfield GS, Spettigue W (2003). Olanzapine use as an adjunctive treatment for hospitalized children with anorexia nervosa: case reports. International Journal of Eating Disorders 33, 98–103.
Bosanac P, Kurlender S, Norman T et al. (2007). An open-label study of quetiapine in anorexia nervosa. Human Psychopharmacology 22, 223–230.
Brambilla F, Garcia CS, Fassino S et al. (2007). Olanzapine therapy in anorexia nervosa: psychobiological effects. International Clinical Psychopharmacology 22, 197–204.
Carter WP, Hudson JI, Lalonde JK et al. (2003). Pharmacologic treatment of binge eating disorder. International Journal of Eating Disorders 34, S74–S88.
Claudino AM, de Oliveira IR, Appolinario JUC et al. (2007). Double-blind, randomized, placebo-controlled trial of topiramate plus cognitive-behavior therapy in binge-eating disorder. Journal of Clinical Psychiatry 68, 1324–1332.
Claudino AM, Hay P, Lima MS et al. (2006). Antidepressants for anorexia nervosa. Cochrane Database of Systematic Reviews 1, CD004365.
Crisp AH, Lacey JH, Crutchfield M (1987). Clomipramine and ‘drive’ in people with anorexia nervosa. British Journal of Psychiatry 150, 355–358.
Crow SJ, James E, Mitchell JE et al. (2009). What potential role is there for medication treatment in anorexia nervosa? International Journal of Eating Disorders 42, 1–8.
Dally P, Sargant W (1966). Treatment and outcome of anorexia nervosa. British Medical Journal 2, 793–795.
Dennis K, Le Grange D, Bremer J (2006). Olanzapine use in adolescent anorexia nervosa. Eating and Weight Disorders 11, e53–e56.
Fairburn CG, Harrison PJ (2003). Eating disorders. Lancet 361, 407–416.
Fallon BA, Walsh BT, Sadik C et al. (1991). Outcome and clinical course in inpatient bulimic women: a 2-to-9-year follow-up study. Journal of Clinical Psychiatry 52, 272–278.
Faris PL, Kim SW, Meller WH et al. (2000). Effect of decreasing afferent vagal activity with odansetron on symptoms of bulimia nervosa: a randomized double-blind trial. Lancet 355, 792–797.
Fassino S, Leombruni P, Daga G et al. (2002). Efficacy of citalopram in anorexia nervosa: a pilot study. European Neuropsychopharmacology 12, 453–459.
Fichter MM, Kruger R, Rieg W (1996). Fluvoxamine in prevention of relapse in bulimia nervosa: effects on eating-specific psychopathology. Journal of Clinical Psychopharmacology 16, 9–18.
Fisman S, Steele M, Short J et al. (1996). Case study: anorexia nervosa and autistic disorder in an adolescent girl. Journal of the American Academy of Child and Adolescent Psychiatry 35, 937–940.
Flament MF, Corcos M, Igoin L et al. (1994). Treatment of normal-weight bulimia nervosa with fluvoxamine: negative results from a controlled double-blind study with 103 outpatients. Presented at the European Regional Symposium of the World Psychiatric Association: Developmental Issues in Psychiatry, Lisbon, 10–14 July 1994.
Fluoxetine Bulimia Nervosa Collaborative Study Group (1992). Fluoxetine in the treatment of bulimia nervosa: a multicenter, placebo-controlled, double-blind trial. Archives of General Psychiatry 49, 139–147.
Gadde KM, Franciscy DM, Wagner II HR et al. (2003). Zonisamide for weight loss in obese adults: a randomized controlled trial. Journal of the American Medical Association 289, 1820–1825.
Garfinkel PE, Garner DM (1982). The hospital management. In Anorexia Nervosa: A Multidimensional Perspective (p. 248). New York, NY: Brunner/Mazel.
Golay A, Laurent-Jaccard A, Habicht F et al. (2005). Effect of orlistat in obese patients with binge eating disorder. Obesity Research 13, 1701–1708.
Goldberg SC, Halmi KA, Eckert ED et al. (1979). Cyproheptadine in anorexia nervosa. British Journal of Psychiatry 134, 67–70.
Golden NH, Iglesias EA, Jacobson MS et al. (2005). Alendronate for the treatment of osteopenia in anorexia nervosa: a randomized, double-blind, placebo-controlled trial. Journal of Clinical Endocrinology and Metabolism 90, 3179–3185.
Goldstein DJ, Wilson MG, Thompson VL et al. (1995). Long-term fluoxetine treatment of bulimia nervosa. British Journal of Psychiatry 166, 660–666.
Goodwin GM, Bowden CL, Calabrese JR et al. (2004). A pooled analysis of 2 placebo-controlled 18-month trials of lamotrigine and lithium maintenance in bipolar I disorder. Journal of Clinical Psychiatry 65, 432–441.
Grinspoon S, Thomas E, Pitts S et al. (2000). Prevalence and predictive factors for regional osteopenia in women with anorexia nervosa. Annals of Internal Medicine 133, 790–794.
Gross HA, Ebert MH, Faden VB et al. (1981). A double-blind controlled trial of lithium carbonate in primary anorexia nervosa. Journal of Psychopharmacology 1, 376–381.
Gross HA, Ebert MH, Faden VB et al. (1983). A double-blind trial of delta9-tetrahydrocannabinol in primary anorexia nervosa. Journal of Clinical Psychopharmacology 3, 165–171.
Grucza RA, Przybeck TR, Cloninger CR (2007). Prevalence and correlates of binge eating disorder in a community sample. Comprehensive Psychiatry 48, 124–131.
Guerdjikova Al, McElroy SL, Kotwal R (2008). High-dose escitalopram in the treatment of binge-eating disorder with obesity: a placebo-controlled monotherapy trial. Human Psychopharmacology: Clinical and Experimental 23, 1–11.
Guerdjikova Al, McElroy SL, Welge JA et al. (2009). Lamotrigine in the treatment of binge-eating disorder with obesity: a randomized, placebo-controlled monotherapy trial. International Clinical Psychopharmacology 24, 150–158.
Halmi KA, Eckert E, LaDu TJ, Cohen J (1986). Anorexia nervosa: treatment efficacy of cyproheptadine and amitriptyline. Archives of General Psychiatry 43, 177–181.
Halmi KA, Eckert E, Marchi P et al. (1991). Comorbidity of psychiatric diagnoses in anorexia nervosa. Archives of General Psychiatry 48, 712–718.
Hoek HW (2006). Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Current Opinion in Psychiatry 19, 389–394.
Hoek HW, Van Hoeken D (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders 34, 383–396.
Holtkamp K, Konrad K, Kaiser N et al. (2005). A retrospective study of SSRI treatment in adolescent anorexia nervosa: insufficient evidence for efficacy. Journal of Psychiatric Research 39, 303–310.
Hoopes SP, Reimherr FW, Hedges DW et al. (2003). Treatment of bulimia nervosa with topiramate in a randomized, double-blind, placebo-controlled trial, part 1: improvement in binge and purge measures. Journal of Clinical Psychiatry 64, 1335–1341.
Home RL, Ferguson JM, Pope HG et al. (1988). Treatment of bulimia with bupropion: a multicenter controlled trial. Journal of Clinical Psychiatry 49, 262–266.
Howell MJ, Schenck CH (2009). Treatment of nocturnal eating disorders. Current Treatment Options in Neurology 11, 333–339.
Hsu LKG, Clement L, Santhouse Jun ESY (1991). Treatment of bulimia nervosa with lithium carbonate: a controlled study. Journal of Nervous and Mental Disease 179, 351–355.
Hudson JI, Hiripi E, Pope HG, Kessler RC (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry 61, 348–358.
Hudson JI, McElroy SL, Raymond NC et al. (1998). Fluvoxamine in the treatment of binge-eating disorder: a multicenter placebo-controlled, double-blind trial. American Journal of Psychiatry 155, 1756–1762.
Hudson JI, Pope HG, Keck PE, McElroy SL (1989). Treatment of bulimia nervosa with trazodone: short-term response and long-term follow-up. Clinical Neuropharmacology 12, S38–S46.
Igoin-Apfelbaum L, Apfelbaum M (1987). Naltrexone and bulimic symptoms. Lancet 7, 1087–1088.
Jonas JM, Gold MS (1988). The use of opiate antagonists in treating bulimia: a study of low-dose vs. high-dose naltrexone. Psychiatry Research 24, 195–199.
Kaplan AS, Garfinkel PE, Darby PL, Garner DM (1983). Carbamazepine in treatment of bulimia. American Journal of Psychiatry 140, 1225–1226.
Katz RL, Keen CL, Litt IF et al. (1987). Zinc deficiency in anorexia nervosa. Journal of Adolescent Health Care 8, 400–406.
Kaye WH, Nagata T, Weltzin TE et al. (2001). Double-blind placebo-controlled administration of fluoxetine in restricting and restricting-purging type anorexia nervosa. Biological Psychiatry 49, 644–652.
Kennedy SH, Goldbloom DS, Ralevski E (1993). Is there a role for selective monoamine oxidase inhibitor therapy in bulimia nervosa? A placebo-controlled trial of brofaromine. Journal of Clinical Psychopharmacology 13, 415–422.
Kennedy SH, Piran N, Warsh JJ et al. (1988). A trial of isocarboxazid in the treatment of bulimia nervosa. Journal of Clinical Psychopharmacology 8, 391–396.
Kotler LA, Devlin MJ, Davies M, Walsh BT (2003). An open trial of fluoxetine for adolescents with bulimia nervosa. Journal of Child and Adolescent Psychopharmacology 13, 329–335.
Lacey JH, Crisp AH (1980). Hunger, food intake and weight: the impact of clomipramine on a refeeding anorexia nervosa population. Postgraduate Medicine Journal 56 (Suppl. 1), S79–S85.
Langtry HD, Gillis JC, Davis R (2003). Topiramate: a review of its pharmacodynamic and pharmacokinetic properties and clinical efficacy in the management of epilepsy. Drugs 54, 752–773.
Lask B, Fosson A, Rolfe U, Thomas S (1993). Zinc deficiency and childhood-onset anorexia nervosa. Journal of Clinical Psychiatry 54, 63–66.
Machado PP, Machado BC, Goncalves S, Hoek HW (2007). The prevalence of eating disorders not otherwise specified. International Journal of Eating Disorders 40, 212–217.
Malhotra S, King KH, Welge JA et al. (2002). Venlafaxine treatment of binge-eating disorder associated with obesity: a series of 35 patients. Journal of Clinical Psychiatry 63, 802–806.
Marrazzi MA, Bacon JP, Kinzie J, Luby ED (1995). Naltrexone use in the treatment of anorexia nervosa and bulimia nervosa. International Journal of Clinical Psychopharmacology 10, 163–172.
McElroy SL, Arnold LM, Shapira NA et al. (2003 b). Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial. American Journal of Psychiatry 160, 255–268.
McElroy SL, Casuto LS, Nelson EB et al. (2000). Placebo-controlled trial of sertraline in the treatment of binge eating disorder. American Journal of Psychiatry 157, 1004–1006.
McElroy SL, Guerdjikova A, Kotwal R et al. (2007 a). Atomoxetine in the treatment of binge-eating disorder: a randomized controlled trial. Journal of Clinical Psychiatry 68, 390–398.
McElroy SL, Guerdjikova AL, Martens B et al. (2009). Role of antiepileptic drugs in the management of eating disorders. CNS Drugs 23, 139–156.
McElroy SL, Hudson JI, Capece JA et al. (2007 b). Topiramate for the treatment of binge eating disorder associated with obesity: a placebo-controlled study. Biological Psychiatry 61, 1039–1048.
McElroy SL, Hudson JI, Malhotra S et al. (2003 a). Citalopram in the treatment of binge-eating disorder: a placebo-controlled trial. Journal of Clinical Psychiatry 64, 807–813.
McElroy SL, Kotwal R, Guerdjikova Al et al. (2006). Zonisamide in the treatment of binge eating disorder with obesity: a randomized controlled trial. Journal of Clinical Psychiatry 67, 1897–1906.
McKnight RM, Park RJ (2010). Atypical antipsychotics and anorexia nervosa: a review. European Eating Disorders Review 18, 10–21.
Mehler C, Wewetzer C, Schulze U et al. (2001). Olanzapine in children and adolescents with chronic anorexia nervosa. A study of five cases. European Child and Adolescent Psychiatry 10, 151–157.
Mehler PS, Mackenzie TD (2009). The treatment of osteopenia and osteoporosis in anorexia nervosa: a systematic review of the literature. International Journal of Eating Disorders 42, 195–201.
Mehler-Wex C, Romanos M, Kirchheiner J, Schulze UME (2008). Atypical antipsychotics in severe anorexia nervosa in children and adolescents: review and case reports. European Eating Disorders Review 16, 100–108.
Milano W, Petrella C, Sabatino C, Capasso A (2004). Treatment of bulimia nervosa with sertraline: a randomized controlled trial. Advances in Therapy 21, 232–237.
Mitchell JE, Christenson G, Jennings J et al. (1989). A placebo-controlled, double-blind crossover study of naltrexone hydrochloride in outpatients with normal weight bulimia. Journal of Clinical Psychopharmacology 9, 94–97.
Mitchell JE, Crow S (2006). Medical complications of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry 19, 438–443.
Mitchell JE, Laine DE, Morley JE, Levine AS (1986). Naloxone but not CCK-8 may attenuate binge eating behavior in patients with the bulimia syndrome. Biological Psychiatry 21, 1399–1406.
Mondraty N, Birmingham LC, Touyz S et al. (2005). Randomized controlled trial of olanzapine in the treatment of cognitions in anorexia nervosa. Australasian Psychiatry 13, 72–75.
Nakash-Eisikovits O, Dierberger A, Westen D (2002). A multidimensional meta-analysis of pharmacotherapy for bulimia nervosa: summarizing the range of outcomes in controlled clinical trials. Harvard Review of Psychiatry 10, 193–211.
Newman-Toker J (2000). Risperidone in anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry 39, 941–942.
Nickel C, Tritt K, Muehlbacher M et al. (2005). Topiramate treatment in bulimia nervosa patients: a randomized, double-blind, placebo-controlled trial. International Journal of Eating Disorders 38, 295–300.
Nielsen S (2001). Epidemiology and mortality of eating disorders. Psychiatric Clinics of North America 24, 201–214.
Norris M, Spettigue W, Buchholz A et al. (2011). Olanzapine use for the adjunctive treatment of adolescents with anorexia nervosa. Journal of Child and Adolescent Psychopharmacology 21, 213–220.
O’Reardon JP, Allison KC, Martino NS et al. (2006). A randomized, placebo-controlled trial of sertraline in the treatment of night eating syndrome. American Journal of Psychiatry 163, 893–898.
Padwal RS, Rucker D, Li SK et al. (2003). Long-term pharmacotherapy for obesity and overweight. Cochrane Database of Systematic Reviews 4, CD004094.
Powers PS, Bannon Y, Eubanks R, McCormick T (2007). Quetiapine in anorexia nervosa patients: an open label outpatient pilot study. International Journal of Eating Disorders 40, 21–26.
Pyle R, Mitchell J, Eckert E, Hatsukami D (1990). Maintenance treatment and 6 month outcome for bulimic patients who respond to initial treatment. American Journal of Psychiatry 147, 871–875.
Reas DL, Grilo CM (2008). Review and meta-analysis of pharmacotherapy for binge-eating disorder. Obesity 16, 2024–2038.
Ricca V, Mannucci E, Mezzani B et al. (2001). Fluoxetine and fluvoxamine combined with individual cognitive-behaviour therapy in binge eating disorder: a one-year follow-up study. Psychotherapy and Psychosomatics 70, 298–306.
Romano SJ, Halmi KA, Sarkar NP et al. (2002). A placebo-controlled study of fluoxetine in continued treatment of bulimia nervosa after successful acute fluoxetine treatment. American Journal of Psychiatry 159, 96–102.
Rothschild R, Quitkin HM, Quitkin FM (1994). A double-blind placebo controlled comparison of phenelzine and imipramine in the treatment of bulimia in atypical depressives. International Journal of Eating Disorders 15, 1–9.
Schüle C, Sighart C, Hennig J, Laakmann G (2006). Mirtazapine inhibits salivary cortisol concentrations in anorexia nervosa. Progress in Neuro-Psychopharmacology & Biological Psychiatry 30, 1015–1019.
Simon J, Schmidt U, Pilling S (2005). The health service use and cost of eating disorders. Psychological Medicine 35, 1543–1551.
Spitzer RL, Devlin MJ, Walsh BT et al. (1991). Binge eating disorder: to be or not to be in DSM–IV. International Journal of Eating Disorders 10, 627–629.
Stacher G, Kiss A, Wiesnagrotzki S et al. (1986). Oesophageal and gastric motility disorders in patients categorized as having primary anorexia nervosa. Gut 27, 1120–1126.
Stunkard A, Berkowitz R, Tanrikut C et al. (1996). D-fenfluramine treatment of binge eating disorder. American Journal of Psychiatry 153, 1455–1459.
Trunko ME, Schwartz TA, Duvvuri V, Kaye WH (2010). Aripiprazole in anorexia nervosa and low-weight bulimia nervosa: case reports. International Journal of Eating Disorders. Published online: 22 February 2010. doi:10.1002/eat.20807.
Vandereycken W (1984). Neuroleptics in the short-term treatment of anorexia nervosa: a double-blind placebo-controlled trial with sulpiride. British Journal of Psychiatry 144, 288–292.
Vandereycken W, Pierloot R (1982). Pimozide combined with behavior therapy in the short-term treatment of anorexia nervosa: a double-blind placebo-controlled crossover study. Acta Psychiatrica Scandinavica 66, 445–450.
Walsh BT, Gladis M, Roose SP (1988). Phenelzine vs. placebo in 50 patients with bulimia. Archives of General Psychiatry 45, 471–475.
Walsh BT, Kaplan AS, Attia E et al. (2006). Fluoxetine after weight restoration in anorexia nervosa; a randomized controlled trial. Journal of the American Medical Association 295, 2605–2612.
Wermuth BM, Davis KL, Hollister E, Stunkard AJ (1977). Phenytoin treatment of the binge-eating syndrome. American Journal of Psychiatry 134, 1249–1253.
Whittal ML, Agras WS, Gould RA (1999). Bulimia nervosa: a meta-analysis of psychosocial and pharmacological treatments. Behavior Therapy 30, 117–135.
Wilfley DE, Crow SJ, Hudson JI et al. (2008). Efficacy of sibutramine for the treatment of binge eating disorder: a randomized multicenter placebo-controlled double-blind study. American Journal of Psychiatry 165, 51–58.
Zhu AJ, Walsh BT (2002). Pharmacologic treatment of eating disorders. Canadian Journal of Psychiatry 47, 227–234.