Anorexia nervosa (AN),
bulimia nervosa (BN) and
binge eating disorder (BED) comprise the currently recognised
eating disorders. Although distinct diagnostic entities, they share certain forms of comorbid psychopathology, particularly anxiety and
mood disorders. BN and BED have been studied most intensively as targets for
pharmacotherapy. The list of drugs tested in
eating disorders is substantial; however, the number of therapeutic classes of medications tested in these conditions is relatively modest.
Antidepressant medications, including
tricyclic antidepressants, selective
serotonin re-uptake inhibitors, as well as some of the novel
antidepressants, have shown evidence of some therapeutic value in both BN and BED. Their efficacy in AN, however, has been disappointing. The pharmacological options for AN are very limited. The number of controlled trials that have been conducted is small, and the research that has been successfully completed has generally failed to demonstrate medication efficacy. Patients with BN typically show reduced
binge eating and purging frequency in medication trials, but rarely attain abstinence. In BED, patients often measure the value of their medication
therapy by its ability to stimulate
weight loss, which is another area on which future
pharmacotherapy may improve. Novel pharmacological interventions are needed for each of these conditions.
Peptide hormones are increasingly being evaluated for
eating disorder treatment, including
ghrelin agonists,
neuropeptide Y1 and -5 antagonists,
orexin receptor antagonists,
corticotropin-releasing factor receptor 2 antagonists, histamine 3 antagonists,
melanocortin 4 receptor antagonists, beta3-adrenoceptor agonists, 5-hydroxytryptamine-2A antagonists and
growth hormone agonists. Although these compounds are in early phases of clinical testing for
eating disorder treatments, data from these studies will be instructive in the quest for effective
pharmacotherapy for these conditions. An overview of the current
pharmacotherapy options for
eating disorders is presented with a discussion of the emerging potential treatments.