Association studies eating disorders

Topiramate can be described as a broad-spectrum neurotherapeutic agent with multiple modes of action, and its weight-loss promoting activity came to attention in trials of therapy for epilepsy [104], and explored further in animal experiments [105, 106], It has also been successfully used in the treatment of obesity associated with eating disorders [107, 108], As specific weight-loss therapy in one short-term [109] and one long-term study [110] in non-diabetics without co-morbid neuropsychiatric conditions, topiramate has been shown to produce a modest dose-related benefit compared to placebo, and with a reasonable side-effect profile. 

There are data to confirm and reject the association of the Cys23Ser S-HT and the Gly22Ser 5-HTj receptor variants, characterized in vitro by reduced agonist potency, with phenotypes such as intractable suicidal ideation (98), ADHD (100), alcohol dependence, and schizophrenia (98,99,109-116). While the -1348 A/G polymorphism of the S-HT receptor has been associated with the negative symptoms of schizophrenia, other studies of eating disorders appear to be equivocal. A body of evidence is available, however, that S-HT variants may be associated with psychotic symptoms in Alzheimer s patients (94,100,117,118). 

Atypical Antidepressants. None of the so-called atypical antidepressants have been tested in the treatment of AN. However, mianserin, an antidepressant available in Europe, has been found to increase body weight in patients with various depressive disorders. Although bupropion (Wellbutrin, Zyban) has not been tested in the treatment of AN, it is effective in the treatment of BN. However, immediate-release bupropion is associated with an especially high risk for seizures in these patients and is therefore contraindicated in those with eating disorders. The seizure risk associated with sustained-release bupropion remains unclear at this time, as the doses studied have not been as high as those for immediate-release bupropion. 

Self-conscious anxiety, associated with the developmental changes just described, can be exacerbated by parental over-concern, particularly by mothers. Such over-concern occurs more frequently in mothers who themselves have, or have had, an eating disorder or who have been obese. As most family studies have been correlational, it is difficult to know whether family dysfunction contributes to the eating disorder, whether the distortions of eating behaviour in the affected daughter causes the family dysfunction, or whether some common other factor contributes to both (Polivy and Herman 2002). 

Placebo-controUed studies In a 16-week, double-blind, placebo-controlled, flexible-dose study of lamotrigine in binge-eating disorder associated with obesity, 51 outpatients were randomized to either lamotrigine (n = 26) or placebo (n = 25) [146 ]. Four patients withdrew because of adverse events (lamotrigine, n = 3 placebo, n = 1), the most common of which were headache (35% versus 28%), insomnia (35% versus 20%), somnolence (27% versus 8%), rash (15% versus 12%), and dry mouth (15% versus 0%). 

Use of ephedrine is sometimes associated with dependence (Gruber and Pope 1998). One study reported a high incidence of eating and body-image disorders among ephedrine users, but this is likely confounded by the fact that the sample consisted entirely of female weightlifters and is likely not to represent the greater population. 

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