Treatments for AN - Drug Therapy

Question 1

How are drug treatments effective

Answer 1

Biochemical mechanisms (dopamine and serotonin) should be able to alter neurotransmitter activity may benefit AN symptoms.

Question 2

Two types of drug treatments

Answer 2

Antidepressants
Antipsychotics

Question 3

What do antidepressants do

Answer 3

Increase serotonin/ serotonin and noradrenaline in synapse

Question 4

What do antipsychotics do

Answer 4

Dopamine abnormally high in AN. Block postsynaptic receptors so dopamine cant bind, reducing signals.

Question 5

Two type of antidepressant drugs

Answer 5

SSRIs (selective serotonin reuptake inhibitors)
SNRIs (serotonin-noradrenaline reuptake inhibitors)

Question 6

Why does low serotonin cause AN

Answer 6

may be direct cause of AN or be because AN is co-morbid with depression

Question 7

What does serotonin do normally

Answer 7

remaining in synapse are normally removed by process of reuptake
Taken back into presynaptic neuron through serotonin transporter

Question 8

What happens to serotonin when drug is taken

Answer 8

block serotonin reuptake in presynaptic so excess serotonin is not recycled, instead stays in synapse and repeatedly binds with postsynaptic receptors

Question 9

How do SSRIs and SNRIs help people with AN

Answer 9

Extends the appetite-enhancing effects of serotonin

Question 10

How do SNRIs work

Answer 10

-Work in similar way to SSRIs but target noradrenaline as well as serotonin (inhibiting reuptake of both serotonin and adrenaline)

Question 11

What do SNRIs suggest

Answer 11

low serotonin is not only neurotransmitter dysfunction that afffects AN

Question 12

What happens do SGAs do to neurotransmitters

Answer 12

Dopamine antagonists = blocks postsynaptic dopamine receptors without activating them, reducing dopamine activity
Block D2/D3 and serotonin 5HT2A receptors
Increase grehlin

Question 13

How do SGAs help with anorexia

Answer 13

Olanzopine = decrease obsessive thoughts (anorexic ruminations)
Ghrelin = decrease fullness and encourage food intake -> Van der Zwaal 2012

Question 14

Atypical second-generation antipsychotics

Answer 14

SGAs - Olanzopine

Question 15

Why is it a weakness to just treat AN with SGAs or SSRIs/SNRIs

Answer 15

-Weight gain = dealing with symptoms but not underlying causes. Make them mentally worse because people with AN are scared to gain weight.

Question 16

Strength of SGAs

Answer 16

-Boachie et al (2003)
- Olanzapine to treat 4 children with AN
-Gained weight (under 1kg a week)
-Experienced less anxiety at mealtimes, with few side effects

Question 17

Counter argument to SGAs

Answer 17

Kafantaris et al (2011) = 15 adolescents given olanzapine
-gained weight and improved eating attitudes BUT at same rate as control group

-Case studies limited (have no control group)
-Used randomised control trial
-Findings from RCTs have been mixed

Question 18

Weakness study

Answer 18

Lebow et al (2013): SGAs
-increase BMI & body satisfaction BUT greater anxiety and worse overall symptoms
-No sig dif from placebo

Question 19

Another weakness of drugs effectiveness - look at only symptoms

Answer 19

-Drugs look at symptoms of AN not causes
Drugs reduce symptoms of AN by stabilising dysfunctional neurotransmitter systems in the brain
Temporary and reversible reduction in symptoms is not the same as treating the cause (ultimately genetic or psychological)
Psychological therapy such as CBT might be preferable (with few side effects)
National Institute for Health and Care Excellence (NICE) – states that drugs should not be used as a primary or only treatment for patients with anorexia nervosa, and there is very little evidence that states that drugs are a useful treatment for anorexia.

Question 20

Application

Answer 20

Most side effects are mild to moderate some are serious but rare. Side effects can be controlled and reduced through monitoring, adjustment of dose and in some cases additional medication.
Knowledge of side effects increases acceptability for people with AN = more likely to continue treatment