Drug Treatment For Anorexia

Question 1

What is the rationale behind using drug therapy to treat anorexia?

Answer 1

-AN patients often have low levels of serotonin and noradrenaline. Serotonin linked with suppression of apprentice, low levels link to bingeing and depression.
-If disruption to serotonin = anxiety which can trigger AN.

Question 2

Study about serotonin levels and anorexia

Answer 2

-Bailer
-Found higher serotonin in women who showed most anxiety - disruption in serotonin leads to anxiety.

Question 3

What type of approach is needed to treat anorexia?

Answer 3

-Multi-disciplinary approach
-CBT, psychotherapy, nutrition counselling, family therapy and pharmacotherapy.
-Gaining weight may show physical improvement but not necessarily psychological.

Question 4

Who publishes guidelines for treating mental illnesses and what do they suggest about treating anorexia?

Answer 4

-NICE (National Institute for Health and Care Excellence)
-Drugs not to be used as first instance as don’t help with core symptoms or promote healthy weight gain.
-Drugs used to treat co-morbid factors like anxiety and OCD.

Question 5

Is there medication that treats the primary cause of anorexia?
What are the 3 classes of drugs used to treat patients with AN?

Answer 5

1) Anti-depressants
2) Atypical antipsychotics
3) Mood stabilisers

Question 6

What are the 2 main types of medication used to treat anorexia?

Answer 6

• SSRI’s (anti-depressant)
• Olanzapie (atypical anti-psychotic)

Question 7

What are SSRI’s?
How do they work?
What do they help with?

Answer 7

-Anti-depressant
-block reuptake of serotonin in pre-synaptic neuron. More S in synapse so more passed to post-synaptic neuron increasing binding and levels of serotonin.
-Anxiety and depression that come with AN

Question 8

What are two studies which show how effective SSRI’s are in treating AN?

Answer 8

-Fassino et al: Citalopram didn’t help w weight gain but did with depression and obsessions
-Kaye et al: High doses of fluoxetine can help prevent relapse when finished therapy and on maintenance dose

Question 9

Why is a maintenance dose of SSRI’s used?

Answer 9

-Serotonin dysfunction can remain after recovery so keep on maintenance dose to prevent relapse

Question 10

Describe how SSRI’s work within neurons to increase serotonin

Answer 10

-SSRI sits in the pre-synaptic transporters to stop serotonin being reabsorbed
-Serotonin builds up in synapse between neurons and sends correct message, increases levels of serotonin.
-Selective as only target serotonin
-Binds with receptor sites more as in synaptic gap, produce more S.
-Reduces depression and increases appretite

Question 11

What are the side effects of SSRI’s?

Answer 11

-Weight gain, difficult for AN patient as not what they want so may not continue taking
-Pain in joints and muscles
-Upset stomach, nausea. Don’t know if side effect or sympt as may have thrown up to lose weight
-Dizzy
-Drowsiness
-Dry mouth
-Agitation
-Young adults and children more likely to have suicidal thoughts when taking. Doubled from 1% to 2% to 2-4%

Question 12

First gen anti-psychotics and anorexia
-Example of drug and two studies to show side effects or how effective

Answer 12

-Typical anti-psychotics used. Reduce dopamine, reduce stress response in reward pathway
-Chlorpromazine used, led to inc weight gain but also bad seizures for some patients (Dally and Sargeant)
-Silverstone: achieve weight gain but doesn’t treat co-morbid symptoms

Question 13

Second gen anti-psychotics and anorexia

Answer 13

-Olanzapine
-Gained weight and had less difficulty eating and lower anxiety (Silverstone)
-Olanzapine most studied drug for AN
-reduces depression, anxiety and core symptoms which make patients less treatment resistant.

Question 14

What are the side effects of FGD’s and SGD’s?

Answer 14

-FGD’s: TD (spasm of muscles in face etc), 30% of people have it and 75% of those are irreversible
-SGD’s: 2% develop agranulocytosis. Fatal blood condition where have less white blood cells, need to be monitored w blood tests, more rare than TD

Question 15

Evaluation

Answer 15

EACH

Question 16

Evidence (2 +, 2+/-, 2-)

Answer 16

+Kaye et al: double blind study. Compared those given fluoxetine and placebo. Fluoxetine more likely to stay on medication up to year as outpatient. Those taking had lower relapse rates due to inc weight and impr of sympt
+Jensen and Mejhede 2000: 3 patients on 3mg Olanzapine a day. Body image more realistic. First 2 months takes a while for drug to work so hard.hunger and weight gain as side effects
-Dally and Sargeant: chlorpromazine led to weight gain but side effects of seizures.
-Vandereycken: anti-psych block dopamine enable patients to show weight gain but didn’t impact others
-Powers et al: Olanzapine w 18 pts and 10 gained weight. 4 didn’t complete and 4 lost weight. Mixed success.
-Ferguson et al: 24 pts taking SSRI’s, 16 w/o. No sig diff between age body weight or symptoms. No sig impact.

Question 17

Comparisons (6)

Answer 17

-Practical issues: clinician prescribes, can monitor if taking when inpatient. AN clever at disposing of it so don’t know if taking it. When out-patient less likely to take it as responsible themselves, lead to relapse
-Relapse: only work as long as take them. If stop them sympt return. Side effect of weight gain may lead them to be distressed and low motivation to take. BUT can help to lower relapse after receive other therapies like CBT. Drugs work on co-morbid which could’ve triggered relapse.
-Side effects: weight gain, not good as AN, may refuse to take. But weight gain positive in stabilising weight which could be life-threatening. SSRI’s better w side effects than anti-psychotics.
-Ethics: anti-psychotics allow to stay in society but chem strait jacket. Social control. Clinicians more power. Not in control so may relapse
-Don’t take environmental and social factors into account which could contribute to disorder like SLT
-High risk: invasive as side effects could impact more on physical health. Need to assess cost and benefit, AN could also have low oestrogen, SSRI’s not effective if it is hormones

Question 18

Credibility

Answer 18

-Patients with co-morbid conditions like anxiety and depression benefit as treats these conditions. Less likely to drop out of treatment, makes other therapies more effective. Lowers relapse rates as more efficacy in inducing weight gain, helping lessen freq of intrusive thoughts.
-Recent improvements: studies shown low levels of anti-psychotics effective and reduce risk of side effects. Drugs last attempt so more impr in care of AN sufferers and more beds in care. Wouldn’t have happened if drugs main therapy (like SZ)