Prozac doesn't prevent anorexia relapse
Last Updated: 2006-06-13 16:36:46 -0400 (Reuters Health)
By Karla Gale
NEW YORK (Reuters Health) - Among anorexia nervosa patients who have returned to a normal weight, the antidepressant fluoxetine (Prozac), and most likely other antidepressants as well, does not decrease the risk of relapse, according to a report in the Journal of the American Medical Association.
Lead author Dr. B. Timothy Walsh believes that treatments such as cognitive behavioral therapy may be of more benefit to these patients.
He told Reuters Health that "researchers have begun to wonder about issues like habit learning and set shifting, because these people tend to be obsessional, rigid, and inflexible, which probably predates the illness. So we are looking for interactions between those characteristics and the development of anorexia nervosa, which may lead to the establishment of very set patterns in thinking about food."
Because patients with anorexia nervosa often have mood, anxiety, and obsessive-compulsive disorders, Walsh, from the College of Physicians and Surgeons of Columbia University in New York, and his team theorized that antidepressant medication might prevent a relapse.
Their study included 93 patients randomly assigned to fluoxetine or placebo, after they underwent treatment and had at least a low-normal weight. Fluoxetine dose started at 20 mg/day, up to a maximum of 80 mg/day, and all patients underwent cognitive-behavior therapy.
A normal weight was maintained for 52 weeks by 26.5 percent of patients in the fluoxetine group and by 31.5 percent in the placebo group. Analysis showed no significant differences between the groups in time to relapse, rate of study completion, weight, depression or other clinical measures.
"Our field needs to evaluate other options such as atypical antipsychotics and see how much merit there is in that option," Walsh said. Atypical antipsychotics, such as olanzapine, lead to weight gain in most patients. "But for it to be successful we need something more than a medication that induces weight gain, because how they view their body is very important to them."
Since anorexia "is probably not a disorder of appetite, but instead appears to be more about denying and resisting the normal drive to eat," he doesn't anticipate much benefit even from these drugs.
On the other hand, he said, "maybe we should back off and stop thinking about intervening with drugs and think of interventions that are more specific for anorexia nervosa." He did note, however, that anorexic patients who also have depression or anxiety, should be treated with the appropriate medications.
He also suggests that physicians and therapists think of the condition as an addiction, in which "something about the illness has become 'rewarding,' despite the fact that there's a lot of suffering involved."
"The fixed behavior patterns are so remarkable, that even if patients can admit that they are too thin, and this is hurting them medically, it is not sufficient to change their behavior," Walsh added. "It's quite an enigma."
SOURCE: Journal of the American Medical Association, June 14, 2006.
