Study Finds Antidepressant May Not Prevent Anorexia Relapse
People with ]]>anorexia nervosa]]> have altered thoughts and unrealistic perceptions about food, weight, and body image that lead them to diet excessively. Anorexia is treated with a weight restoration program that may require hospitalization. Even after successful treatment, many people who have been treated for anorexia will eventually relapse and require hospitalization. Since anorexia is associated with ]]>depression]]> , physicians commonly prescribe antidepressants as part of a treatment plan for anorexia, even though evidence of their effectiveness is limited.
A new study in the June 14, 2006 issue of the Journal of the American Medical Association found that the antidepressant fluoxetine was no more beneficial than placebo in preventing relapse in people with anorexia.
About the Study
Participants included 93 women in New York and Toronto who were between the ages of 16-45 and had been diagnosed with anorexia. All of the participants completed an inpatient treatment program before the study began, during which they restored their body weight so that their body mass index (BMI, a measure of weight in relation to height) was at least 19 (considered “normal” weight). The participants were randomly assigned to receive either fluoxetine or a placebo for 12 months. During the 12 months, they received behavioral therapy and monitoring from psychologists and psychiatrists.
Fifty-three (57%) of the participants did not complete the study, typically due to relapse or lack of adherence to therapy sessions or medication. There was no significant difference in the time-to-relapse between the participants taking fluoxetine and those taking the placebo. By the end of 12 months, 43% of the fluoxetine group and 45% of the placebo group had not relapsed.
How Does This Affect You?
These findings suggest that fluoxetine is no more effective than placebo in preventing relapse in women with anorexia who have restored their body weight. This is significant, since prescribing antidepressants to people recovering from anorexia is common practice. These results, however, are tempered by the high rate of drop outs from the study. They also say nothing about the effectiveness of antidepressants in the initial efforts to restore body weight.
Research is needed to find more effective treatments to help anorexic people maintain their weight, along with better ways to predict who will respond to antidepressants and who will not. In the meantime, these results suggest that fluoxetine, and possibly other antidepressants, should not be relied upon as the sole means to prevent relapse from this notoriously persistent condition.
National Eating Disorders Association
National Institute of Mental Health
Crow SJ. Fluoxetine treatment of anorexia nervosa: important but disappointing results. JAMA . 2006;295(22):2659-2660.
Walsh BT, Kaplan AS, Attia E, et al. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. JAMA . 2006;295(22):2605-2612.
Last reviewed June 2006 by ]]>Richard Glickman-Simon, MD]]>
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