drug treatments for AN

Question 1

NICE guidelines 2004

Answer 1

Do not suggest that drug therapy is used as the first choice of treatment, due to them not helping with the core symptoms of the disorder.

Question 2

New Zealand guidelines 2011

Answer 2

recommend that family therapy, CBT and dietary advice should be the first choice therapies, but acknowledge drug treatment can be used alongside these to help with co-morbid symptoms.

Question 3

why are SSRIs used?

Answer 3

due to the link between low serotonin and AN, SSRIs are often prescribed

Question 4

what is an example of an SSRI used?

Answer 4

Fluoxetine is used, which works by increasing serotonin levels. it is assumed that this will improve the depression and anxiety behavioural symptoms associated with AN.

Question 5

how do SSRIs work?

Answer 5

• SSRIs block the transporter molecules on the pre-synaptic neurone.
• this stops the process of re-uptake leaving serotonin neurotransmitters in the synaptic gap.
• hence more serotonin is now available in the synapse, resulting in more serotonin binding to the receptors on the post-synaptic neurone and increased messages being sent between neurones.

Question 6

why are anti-psychotics used?

Answer 6

• first generation antipsychotics are also prescribed due to the link between dopamine and AN.
• by reducing excess dopamine, it is thought the stress response in the reward pathway will also increase.

Question 7

Chlorpromazine
(first generation antipsychotic)

Answer 7

• has been used and has led to increase weight gain.
• however for some patients it also caused severe seizures (Dally and Sargant 1966)
• Silverstone 2005 also identified that whilst anti-psychotics enabled patients to achieve weight gain, they did not treat any of the co-morbid symptoms.

Question 8

second generation anti-psychotics

Answer 8

• have also been used to treat AN
• Patients who were prescribed Olanzapine not only gained weight but also reported less difficulty with eating, as well as lower levels of anxiety (Silverstone 2005)

Question 9

side effects of drug therapies

Answer 9

• some individuals express an increase in suicidal thoughts when taking SSRIs
• research has shown that the chances of suicidal thoughts doubles when taking anti-depressants (inc. SSRIs) when compared to placebo.