The antidepressant drug Prozac does not help prevent relapses in patients recovering from anorexia nervosa, new research shows.
Researchers from Columbia University and University of Toronto compared treatment with Prozac (fluoxetine) to that with placebo in patients who had recently regained weight after intensive hospital-based treatment. They found no significant difference in relapse rates between the two groups.
Fewer than half of the patients -- 43 percent of those taking Prozac and 45 percent of those taking placebo -- maintained their weight gains for a year.
The large, rigorously designed trial is the latest of many studies to show no benefit for drug therapy in the treatment of anorexia nervosa, a serious psychiatric illness that mainly affects women and adolescent girls.
“A lot of medications have been studied, but the findings have been pretty disappointing,” says University of Minnesota psychiatry professor Scott J. Crow, MD. “We haven’t got a good drug option for anorexia right now.”
The findings are reported in The Journal of the American Medical Association.
Death Rate Is High
The search for better treatments is critical, Crow tells WebMD, because anorexia nervosa is a deadly disease with a mortality rate as high as 10 percent to 15 percent.
“Actually, the only psychiatric illness that may have a higher mortality rate is opiate dependence,” he says. “And anorexia nervosa has the highest suicide rate of any psychiatric disorder.”
Although treatments aimed at helping patients regain a healthy weight are often successful, relapses are common.
B. Timothy Walsh, MD, who led the latest study, tells WebMD that roughly 50% of patients relapse within a year.
Antidepressants are often prescribed to patients with the eating disorder, even though studies have consistently shown that drugs have little impact on outcomes during the initial phase of treatment, when patients are still underweight.
Walsh and colleagues conducted the newly published study to determine if antidepressants help prevent relapses after weight has been restored.
More to Anorexia Than Depression
The trial included 93 female anorexia nervosa patients (average age was early 20s) who gained weight as inpatients or day patients at the New York State Psychiatric Institute or Toronto General Hospital.
Once the weight-gain phase of treatment ended, all the patients continued to get psychiatric counseling in the form of cognitive behavioral therapy and monitoring by a psychiatrist. Forty-nine were randomly assigned to treatment with Prozac and 44 were treated with placebo for up to a year. Neither the patient nor her psychiatrist knew which drug treatment they were getting.
The relapse rate was high in both groups, and there was no significant difference between the two treatment groups in the time to relapse.
Depression and other psychiatric illnesses that are helped with antidepressants are common among people with anorexia nervosa. But the findings show that there is more going on with the disorder, Walsh says.
Walsh is a professor of psychiatry at New York State Psychiatric Institute/Columbia University Medical Center.
“This isn’t simply depression or anxiety,” he says. “If it were, we would expect medication to be more effective.”
Psychiatric treatments like cognitive behavioral therapy are widely believed to have some benefit in the treatment of anorexia nervosa. And a new type of family therapy in which eating is closely monitored by a parent is showing promise for the treatment of children and young adolescents with the eating disorder.
Walsh and Crow agree that much more research is needed to identify the best treatment strategies for helping patients with anorexia nervosa gain weight and avoid relapse.
Crow says the stigma that accompanies eating disorders may have had a chilling impact on this research in the past.
“There has been a little bit of a feeling that all an anorexic needs to do to get better is start eating, but it is nowhere near that simple,” he says. “Nobody would say [to a psychotic] that they should just stop hallucinating.”
SOURCES: Walsh, B.T. The Journal of the American Medical Association, June 14, 2006; vol. 295: pp. 2605-2612. B. Timothy Walsh, MD, professor of psychiatry, New York State Psychiatric Institute at Columbia University Medical Center, New York City. Scott J. Crow, MD, professor of psychiatry, University of Minnesota, Minneapolis.