Treatments of anorexia - Drug treatments Flashcards
What is the rationale for using drug treatments for anorexia?
Low levels of some neurotransmitters such a serotonin and noradrenaline. Serotonin is related with suppression of appetite and mood, low levels are linked to bingeing and depression. Bailer found significantly higher serotonin activity in women who showed the most anxiety, suggesting the increased serotonin in those with anorexia.
What are the NICE (National Institute for Health and Care Excellence) guidelines for treating mental illness?
The NICE suggest that drugs are not used as a first choice as they tend not to help with core symptoms, nor do they promote healthy weight gain.
What are the most common drugs prescribed to patients?
Anti-depressants, atypical antipsychotics and mood stabilisers.
What are the two main types of medication used to treat AN?
- Selective serotonin reuptake inhibitors (SSRIs)
- Olanzapine
What is an SSRI?
A form of anti-depressants that work by blocking the reuptake of serotonin in the presynaptic neurons. This makes more serotonin available in the synapse and so more is passed to the post-synaptic neuron which increases levels overall.
Fassino et al (2002)
Found that Citalopram did not help with weight gain but did help with depression, obsessions and compulsions.
Kaye et al (2001)
Suggests that at higher doses, fluoxetine can help to prevent relapse when an individual has finished therapy and is receiving a maintenance dosage.
What does the SSRI do?
They specifically target serotonin ‘selective’. Blocks the reuptake to cause the synapse to be flooded with serotonin which increases levels which can help with the anxiety and depression that comes with AN.
What are the side effects of SSRI?
- Weight gain (not good for patients with AN)
- Pain in the joints or muscles
- Upset stomach (leading to weight loss)
- Drowsiness
- Dry mouth
- Agitation
- More likely to have suicidal thoughts (RARE) but this is more likely to occur in children and young adults but onset is adolescence.
What is the main function of antipsychotic drugs?
They focus mainly on dopamine function, suggesting that altered dopamine functioning in the striatum may contribute to anorexia.
What is Olanzapine?
An a-typical antipsychotic drug which is also used to treat anxiety as it blocks the absorption of dopamine and serotonin. The medication has been found to help some people with anorexia gain weight and change obsessive thought patterns.
Are first generation antipsychotics prescribed?
Yes because of the link between dopamine and AN. By reducing excess dopamine, it is thought the stress response in the reward pathway will also decrease. Chlorpromazine has been used and has led to increased weight gain but also caused severe seizures and did not treat any of the co-morbid symptoms.
Are second generation drugs used to treat AN?
Olanzapine has been proven to work as they reported less difficulty with eating, lower anxiety levels and gaining weight. It has also been linked to reduced depression, anxiety and core eating disorder symptoms which make patients less resistant to treatment and help with compliance.
What is the process for taking anti-psychotics?
- Must be taken at the earliest stage so there is less chance of relapse. However, this is difficult as drug therapies are used as a last resort for anorexic patients.
- Taken for a certain amount of time (12 months) and then a maintenance dosage is given
- Individual is carefully monitored for changes in symptoms and side effects
What are the side effects for typical antipsychotics?
- Muscle tightening in neck
- Decrease in movement
- Motor restlessness and fidgeting
- Sedation
- Decrease in emotional spontaneity
- Decreases motivation
What are the side effects for atypical antipsychotics?
- Similar side effects for typical antipsychotics
- Has a rare side effect of dangerously low white blood cells which means low immune system.
- Weight gain
- Severe anxiety
- Insomnia
-Low blood pressure - Increased risk of suicide
Strength - Patients with comorbid symptoms may benefit from treatment
Treatment would target symptoms such as that of depression and anxiety that caused the onset of anorexia in the first place, this could then stop them from coming back after treatment is successful.
Strength - Practical issues for this treatment
- Clinician provides the dosage of medication and an in-patient is more likely to take it as they are being watched. They also believe the clinician due to their expert power.
Weakness - Practical issues for this treatment
Smart patients may lie and trick the clinician into believing they have taken the dosage when they haven’t. Also, SSRI’s take longer to have an impact (average is 2 weeks)
Weakness - Mondraty et al
Approximately one half of patients are resistant to psychological, behavioural, pharmaceutical, family, nutritional and unconventional therapies. Therefore, it may not actually work as most are resistant.
Weakness - relapse
Gaining weight is a side effect which could mean that patients stop taking treatment in order to stay away from the side effect, meaning they don’t get better and their symptoms get worse. Making the treatment ineffective.
Strength - relapse
Are less likely to drop out of therapy if they are also having drugs. If the co-morbid conditions can be managed, other therapies can be successful. As the drugs combat the anxiety, the less change of relapse.
Strength - evidence of effectiveness (Kaye et al)
Those patients on fluoxetine were much more likely to stay on medication up to a year into their outpatient treatment. They also found that fluoxetine had much lower relapse rates, measured by increased body weight and improvements in symptoms.
Strength - evidence of effectiveness (Jensen and Mejihede)
Positive impact was seen on body image of 3 case studies after olanzapine. However, they commented that the first two months were difficult as it takes long for the drug to take effect and reported side effects included hunger and weight gain.
Weakness - evidence of effectiveness
Dally and Sargant reported that Chlorpromazine did lead to weight gain but severe side effects such as seizures.
Weakness - evidence of effectiveness
Ferguson et al found that there was no significant differences between patients in the same ward who had SSRIs and those who didn’t. This suggests that the use of drugs had no significant impacts.
Weaknesses - side effects
One of the side effects of SSRIs is that gaining weight is one of them. This may be good for the clinician but would stop a patient with anorexia for wanting to take the drug.
Strength - side effects
However, the side effects of weight gain could be seen as a good thing in helping stabilising weight which could be at a life threatening point.
Strengths - recent improvements
Studies have found that low levels of antipsychotics seem to be effective and also reduce the risk of side effects
Strengths - recent improvements
As drugs are a last resort for AN patients, there have been vast improvements in the case of AN sufferers. We are now more aware of early symptoms and there has been an increase in the number of beds in a patient care facility. This would not occur if drugs were a main therapy.
