Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition and physical health consequences.

Abstract

The pharmacological treatment of patients with an eating disorder (ED) often includes medications to treat their ED, comorbid mental health problems, malnutrition and the physical health problems resulting from it. The currently approved pharmacological treatment options for EDs are limited to fluoxetine for bulimia nervosa (BN) and - in some countries - lisdexamfetamine for binge eating disorder (BED). Thus, there are no approved pharmacological options for anorexia nervosa (AN), even though study results for olanzapine and dronabinol are promising. Topiramate might be an additional future option for the treatment of BN and BED. Selective serotonin reuptake inhibitors (SSRI), mirtazapine and bupropion could be considered for the treatment of comorbid unipolar depression. However, AN and BN are contraindications for bupropion. For ED patients with a manic episode, we recommend olanzapine in AN and risperidone in BN and BED; whereas for bipolar depression, olanzapine (plus fluoxetine) seems appropriate in AN and lamotrigine in BN and BED. Acute anxiety or suicidality may warrant benzodiazepine treatment with lorazepam. Proton-pump inhibitors, gastroprokinetic drugs, laxatives and hormones can alleviate certain physical health problems caused by EDs. Therapeutic drug monitoring, pharmacogenomic testing, a more restrictive use of "pro re nata" (PRN) medication, an interdisciplinary treatment approach, shared decision making (SDM) and the formulation of common treatment goals by the patients, their family or carers and clinicians could improve treatment success and safety. Novel genetic, immunological, microbiome and brain imaging research as well as new pharmacological developments like the use of psychedelics, stimulants, novel monoaminergic drugs, hormone analogues and drugs which enhance the effects of psychotherapy may extend our therapeutic options in the near future.

• Authors: Hubertus Himmerich, Carol Kan, Katie Au, Janet Treasure
• Journal: Pharmacology & therapeutics (Pharmacol Ther) Vol. 217 Pg. 107667 (01 2021) ISSN: 1879-016X [Electronic] England
• PMID: 32858054 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Chemical References

• Antipsychotic Agents
• Trace Elements

Topics

• Antipsychotic Agents (administration & dosage, adverse effects, therapeutic use)
• Avitaminosis
• Clinical Decision-Making (methods)
• Drug Monitoring (methods)
• Feeding and Eating Disorders (drug therapy, epidemiology, physiopathology, psychology)
• Humans
• Malnutrition (drug therapy, epidemiology)
• Mental Disorders (drug therapy, epidemiology)
• Patient Care Planning
• Pharmacogenomic Testing (methods)
• Sleep Wake Disorders (drug therapy, epidemiology)
• Trace Elements (deficiency)
• Water-Electrolyte Balance (physiology)