Fluoxetine After Weight Restoration in Anorexia Nervosa

University of Toronto, Toronto, Ontario, Canada
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 07/2006; 295(22):2605-12. DOI: 10.1001/jama.295.22.2605
Source: PubMed

ABSTRACT Antidepressant medication is frequently prescribed for patients with anorexia nervosa.
To determine whether fluoxetine can promote recovery and prolong time-to-relapse among patients with anorexia nervosa following weight restoration.
Randomized, double-blind, placebo-controlled trial. From January 2000 until May 2005, 93 patients with anorexia nervosa received intensive inpatient or day-program treatment at the New York State Psychiatric Institute or Toronto General Hospital. Participants regained weight to a minimum body mass index (calculated as weight in kilograms divided by the square of height in meters) of 19.0 and were then eligible to participate in the randomized phase of the trial.
Participants were randomly assigned to receive fluoxetine or placebo and were treated for up to 1 year as outpatients in double-blind fashion. All patients also received individual cognitive behavioral therapy.
The primary outcome measures were time-to-relapse and the proportion of patients successfully completing 1 year of treatment.
Forty-nine patients were assigned to fluoxetine and 44 to placebo. Similar percentages of patients assigned to fluoxetine and to placebo maintained a body mass index of at least 18.5 and remained in the study for 52 weeks (fluoxetine, 26.5%; placebo, 31.5%; P = .57). In a Cox proportional hazards analysis, with prerandomization body mass index, site, and diagnostic subtype as covariates, there was no significant difference between fluoxetine and placebo in time-to-relapse (hazard ratio, 1.12; 95% CI, 0.65-2.01; P = .64).
This study failed to demonstrate any benefit from fluoxetine in the treatment of patients with anorexia nervosa following weight restoration. Future efforts should focus on developing new models to understand the persistence of this illness and on exploring new psychological and pharmacological treatment approaches. Identifier: NCT00288574.

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Available from: Kathleen M Pike, Aug 10, 2015
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    • "Patient outcome: Studies investigating comparable patient populations found 1 year relapse rates after hospital treatment of around 70% (Walsh et al., 2006). Other relapse prevention studies have reduced rates (30–50%; Pike et al., 2003). "
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    ABSTRACT: Experienced Carers Helping Others (ECHO) is a guided self-help intervention for carers of people with eating disorders to reduce distress and ameliorate interpersonal maintaining factors to improve patient outcomes. The aim of this paper is to describe the theoretical background and protocol of a randomised controlled trial that will establish whether ECHO has a significant beneficial effect for carers and the person they care for. Individuals with anorexia nervosa and carers will be recruited from eating disorder inpatient/day patient hospital services in the UK. Primary outcomes are time until relapse post-discharge (patient) and distress (carer) at 12 months post-discharge. Secondary outcomes are body mass index, eating disorder symptoms, psychosocial measures and health economic data for patients and carers. Carers will be randomised (stratified by site and illness severity) to receive ECHO (in addition to treatment as usual) or treatment as usual only. Potential difficulties in participant recruitment and delivery of the intervention are discussed. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 01/2013; 21(1). DOI:10.1002/erv.2193 · 1.38 Impact Factor
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    • "Although medications in most psychotropic medication classes have been studied in small case series or trials in adults, none of them consistently demonstrate systematic effectiveness. There was enthusiasm for the potential for SSRIs (e.g., fluoxetine) as possibly useful to prevent weight loss after acute weight restoration, but a large study now suggests that this is not likely (Walsh et al., 2006). Also, atypical antipsychotics, because of their propensity to lead to weight gain as well as their anxiolytic properties, have been considered potentially useful. "
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    ABSTRACT: OBJECTIVE: Although eating disorders are common psychiatric disorders that usually onset during adolescence, few evidence-based treatments for this age group have been identified. A critical review of treatments used for Anorexia Nervosa (AN) and Bulimia Nervosa (BN) and related conditions (EDNOS) is provided that summarizes the rationale for the treatments, evidence of effectiveness available, and outcomes. METHOD: Critical review of published randomized clinical trials (RCTs). RESULTS: There are only seven published RCTs of psychotherapy for AN in adolescents with a total of 480 subjects. There are only two published RCTs for outpatient psychotherapy for adolescent BN with a total of 165 subjects. There are no published RCTs examining medications for adolescent AN or BN. For adolescent AN, Family-Based Treatment (FBT) is the treatment with the most evidence supporting its use. Three RCTs suggest that FBT is superior to individual therapy at the end of treatment; however, at follow-up differences between individual and family approaches are generally reduced. For adolescent BN, one study found no differences between Cognitive Behavioral Therapy and FBT at the end of treatment or follow-up, while the other found FBT superior to individual therapy. CONCLUSIONS: Although the evidence remains limited, FBT appears to be the first line treatment for adolescent AN. There is little evidence to support a specific treatment for adolescent BN. There is a need for additional studies of treatment of child and adolescent eating disorders. New treatments studies may build on current evidence as well as examine new approaches based on novel findings in the neurosciences about cognitive and emotional processes in eating disorders.
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    ABSTRACT: Anorexia nervosa (AN) is characterized by restricted eating and a relentless pursuit of thinness that tends to present in females during adolescence according to DSM-IV (Table 1). Individuals with AN exhibit an ego-syntonic resistance to eating and a powerful pursuit of weight loss, yet are paradoxically preoccupied with food and eating rituals to the point of obsession. Individuals have a distorted body image and, even when emaciated, tend to see themselves as "fat," express denial of being underweight, and compulsively overexercise. Two types of eating-related behavior are seen in AN. In restricting-type anorexia (AN), individuals lose weight purely by dieting without binge eating or purging. In binge-eating/purging-type anorexia, individuals also restrict their food intake to lose weight but have a periodic disinhi-bition of restraint and engage in binge eating and/or purging, also seen in bulimia nervosa (BN). Anorexia nervosa is often kept hidden by patients who are excessively preoccupied by their current body weight/ shape and are ashamed of any compensatory behaviors they engage in. Illness often becomes apparent when patients become emaciated from gradually losing weight or in the purging subtype when patients become physiologically unsta-ble from excessive self-induced loss of fluids or electrolytes. Onset is typically around puberty and is usually preceded by anxiety disorders and followed by a prolonged clinical course with the highest mortality for any psychiatric illness. Outcome is often hindered by an unwillingness to seek treatment. A limited understanding of etiological mecha-nisms and the lack of powerful treatments are major impediments to providing effective care. Still, there is evidence supporting cautious optimism regarding the development of more effective therapy. For example, although there are no U.S. Food and Drug Administration (FDA) approved medications for AN, some short-term studies suggest that sec-ond-generation antipsychotics may be beneficial. For adolescents who develop AN before the age of 18, Maudsley fam-ily therapy may be an effective alternative. HISTORY The term "anorexia nervosa" is derived from the Greek for lack of appetite and the Latin for nervous origin. The earliest known medical account of AN was from 1689 by Richard Morton, an English physician and a specialist in tuberculosis, who care-fully described the case of an 18-year-old girl who "…fell into a total suppression of her Monthly Courses from a multitude of Cares and Passions of her Mind, but without any Symptom of the Green-Sickness following upon it….I do not remember that I did ever in all my Practice see one, that was conversant with the Living so much wasted with the greatest degree of a Consumption, (like a Skel-eton only clad with skin) yet there was no Fever, but on the contrary a coldness of the whole Body; no Cough, or difficulty of Breathing, nor an appear-ance of any other distemper of the Lungs, or of any other Entrail: No loosness, or any other sign of a Colliquation, or Preternatural expence of the Nu-tritious Juices" (1). In the late 19th century an interest in this condi-tion developed in Europe, after publication of case series of AN by Sir William Gull in England and Charles Lasegue in France, respectively (2, 3). As Sir Gull noted in some patients, "It seemed hardly possible that a body so wasted could undergo exer-cise so agreeably." This illness seems just as perplex-ing more than a century later.
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