Eating disorder treatment

EDReferral.com (www.edreferral.com). This is a leading online database for eating disorders treatment, support, and information. 

MC4R for feeding behaviour, targeting one or both of these recqDtors in addition to understanding the complex cross-talk within the CNS may lead to the development of melanocortin based therapeutics for the treatment of eating disorders [5]. 

When is medication indicated in the treatment of psychiatric illness There is no short answer to this question. At one end of the continuum, patients with schizophrenia and other psychotic disorders, bipolar disorder, and severe major depressive disorder should always be considered candidates for pharmacotherapy, and neglecting to use medication, or at least discuss the use of medication with these patients, fails to adhere to the current standard of mental health care. Less severe depressive disorders, many anxiety disorders, and binge eating disorders can respond to psychotherapy and/or pharmacotherapy, and different therapies can target distinct symptom complexes in these situations. Finally, at the opposite end of the spectrum, adjustment disorders, specific phobias, or grief reactions should generally be treated with psychotherapy alone. 

The current SSRIs in the United States inclnde fluoxetine, fluvoxamine, sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). All effectively treat major depression. In addition, one or more of the SSRIs has been shown effective in the treatment of dysthymic disorder, the depressive phase of bipolar disorder, premenstrual dysphoric disorder, panic disorder, social phobia, obsessive-compnlsive disorder, bnlimia nervosa, and binge-eating disorder. 

OCD is also frequently comorbid with AN in fact, some researchers posit that the eating disorders are a modern variant of OCD peculiar to Western culture. In particular, the propensity for excessive exercise among some patients with AN may indicate the presence of comorbid OCD. Finally, the abuse of alcohol and other substances commonly complicates the presentation and course of AN. Comorbid substance abuse will likely undermine any progress in the treatment of AN and... 

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. 

Although evaluation of obesity is important, the elucidation of patterns of eating behavior is the critical component in the assessment of eating-disordered obese patients. Unfortunately, it is just this aspect of the evaluation that is most often neglected in treatment programs that too narrowly focus on weight reduction. If a careful history is obtained, then BED is not difficult to diagnose. 

Attia E, Schroeder L. Pharmacologic treatment of anorexia nervosa. Int J Eat Disord 2005 37(Supplement) S60-S63. 

Casper RC. How useful are pharmacological treatments in eating disorders Psychophar-macol Bull 2002 36(2) 88-104. 

Husted DS, Shapira NA. Binge-eating disorder and new pharmacologic treatments. Primary Psychiatry 2005 12 46-51. 

Unlabeled Uses Treatment of eating disorders, postconcussional syndrome unresponsive to other treatments... 

I Unlabeled Uses Treatment of binge eating disorder, bipolar disorder, obesity... 

Ellison, A.R., and Fong, J., Neuroimaging in eating disorders. In Hoek, H.W, Treasure, J.L., and Katzman, M.A. eds. Neurobiology in the Treatment of Eating Disorders. Chichester John Wiley... 

The selective serotonin reuptake inhibitors (SSRI) have been used in adults for a wide variety of disorders, including major depression, social anxiety (social phobia), generalized anxiety disorder (GAD), eating disorders, premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD), panic, obsessive-compulsive disorder (OCD), trichotillomania, and migraine headaches. Some of the specific SSRI agents have an approved indication in adults for some of these disorders, as reviewed later in this chapter. The SSRIs have also been tried in children and in adults for symptomatic treatment of pain syndromes, aggressive or irritable ( short fuse ) behavior, and for self-injurious and repetitive behaviors. This chapter will review general aspects of the SSRIs and discuss their approved indications in children and adolescents. 

If relapse does occur, it should first be determined whether the patient was compliant with treatment. If the patient was not compliant, antidepressant medication should resume. If the patient was compliant and had been previously responding to the medication (without significant side effects), the existence of ongoing stressors (e.g., conflict, abuse) or comorbid medical or psychiatric disorders should be considered (anxiety disorder, ADHD, substance abuse, dysthymia, bipolar disorder, eating disorder). 

Hospitalization for eating disorder depends on the weight status of the patient, the presence of medical complications, and the presence of related psychiatric comorbidities, such as depression, suicidal behavior, and OCD. Hospitalization for AN may be brief or extended. Inpatient brief hospitalization (7-14 days) is for patients who have (1) relapsed from previous treatment or have been ill for less than 6 months (2) a weight loss of 10%-15% from normal weight if they have relapsed, or 16%-20% if this is their first episode (3) hypokalemic alkalosis with serum potassium < 2.5 mEq/L and (4) cardiac arrhythmias. To promote rapid weight gain, patients can be placed on a liquid formula... 

Fairburn, C.G. and Cooper, Z. (1993) The Eating Disorder Examination, 12th ed. In Fairburn, C.B. and Wilson, G.T., eds. Binge Eating Nature, Assessment, and Treatment. New York Guilford Press, pp. 317-360. 

Given the current literature, antidepressant therapy should be initiated in youth with SUD and depression if the depressive symptoms persist during a period of abstinence, if such abstinence is unable to be achieved, or early in treatment if there is a history of recurrent depression. The efficacy of buproprion (Wellbutrin) in youth with SUD and depression is currently being explored (Solhkhah and Wilens, unpublished data). The antidepressants have little abuse potential and are generally very safe, although buproprion (Wellbutrin) should be avoided in youth with eating disorders or seizures. 

Psychotropic medication use is associated more with causing difficulties with eating rather than as a treatment for eating disorders. None of the medications investigated in the treatment of primary anorexia nervosa have been shown to be efficacious. Pica is defined as the eating of non-food substances. In the Expert Consensus survey (Rush and Frances, 2000) 63% of the respondents stated that no medication treatment is indicated for this disorder. Should medication be considered, then SSRI medications were most commonly endorsed. Another alternative is treatment with mineral or nutritional supplements, such as zinc or iron. 

Fluoxetine is manufactured by Eli Lilly under the name Prozac, as a 10-mg green football-shaped tablet or a 20-mg green and white capsule. It was the first SSRI introduced for the treatment of depression and anxiety disorders. Fluoxetine is prescribed for obsessive-compulsive disorder, the eating disorder bulimia nervosa, and panic disorder. 

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