Pharmacotherapy of Eating Disorders

Lee, Young Ho

Abstract

One of the true success stories in clinical neurosciences over the last 30 or so years has been the development of effective drug therapies of several psychiatric disorders including schizophrenia. It is true that the effects of drug are not disease-specific. However, it if logical to find medications that will be effective in eating disorders. In spite of many limitations, some tentative conclusions regarding the role of medications in the treatment of eating disorders can now be drawn. These conclusions as a whole revealed the following ; 1) There were no clear difference in efficacy among the various drugs used. 2) Short-term abstinence rates are about 30%, and overall reductions in bulimic behavior are about 70%. 3) A significant relapse rate(30-45%) is observed if patients are followed for 4-6 months. 4) There are few predictors of who will respond to these medications. 5) Dropout rates tend to be high, in part because of side effects and in part because of some patients' attitudes toward medication use. 6) The doses used in these treatment studies have generally been similar to those employed in the treatment of depression, and with a single exception which the high-dose regimen (60 mg of fluoxetine) was clearly superior to the loll dose (20 mg of fluoxetine). However, Wakeling(1995) suggested that the pharmacotherapy for eating disorders clearly had some limited beneficial effects, at least in the short term and that many unanswered questions remained related to the acceptability of this form of treatment, the unwanted effects of drugs and the longer-term efficacy. He also insisted that at the present level of knowledge, pharmacotherapy should not be used as a sole treatment approach but only within an overall treatment programme. In clinical practice, pharmacotherapy is frequently used in the treatment of eating disorders in combination with various psychotherapuetic approaches. Therefore, the clinicians, who engage in the treatment of patients with eating disorders, should be able to identify the patients for whom drug therapy is desirable and be accustomed to the differences with the pharmacotherapy of other psychiatric patients. The author will review the results of previous studies on pharmacotherapy for eating disorders and demonstrate several important issues in the practice of pharmacotherapy for the patients with eating disorders.