The Elusive Search for Effective Treatment for Anorexia Nervosa
In the 1970s, various medications including lithium, zinc, THC, and anti-anxiety drugs were tried to treat anorexia nervosa. However, none of these attempts were successful in helping patients with the disorder overcome rigid thought patterns and regain a healthy weight. Even widely prescribed drugs like Prozac and SSRIs had minimal effects. Evelyn Attia, the director of the Center for Eating Disorders at New York Presbyterian Hospital, conducted a study in which patients were given an antipsychotic drug called olanzapine. While this drug showed a slight increase in BMI for some patients, it did not improve cognitive and psychological symptoms significantly. Unfortunately, this remains the only medication trial to produce any positive effect for anorexia, yet the effects were still minimal.
Anorexia nervosa is the deadliest eating disorder and has a higher death rate than opioid-use disorder. Studies have shown that people hospitalized for anorexia are more than five times more likely to die compared to their peers without the disorder. Despite the National Institutes of Health allocating over $100 million for researching anorexia, no reliable compound has been discovered to effectively treat the disorder.
Bulimia nervosa and binge-eating disorder have shown more promising results with fluoxetine (Prozac) being FDA-approved for treatment, along with the off-label use of other SSRIs. Vyvanse, an ADHD drug, was approved for binge-eating disorder soon after it was officially recognized. However, the same success has not been achieved with anorexia. Scott Crow, a psychology professor at the University of Minnesota, expressed the frustration over the lack of success even after trying several different approaches.
The baffling discrepancy in the response to medications between anorexia and other eating disorders has left specialists and researchers puzzled. Changes in brain activity associated with anorexia have been studied, revealing differences in how neurotransmitters serotonin and dopamine, both involved in the brain’s reward system, function in anorexia patients.
Experts theorize that underlying differences in brain chemistry and function, exacerbated by malnourishment, may contribute to the extreme aversion to eating seen in anorexia patients. Researchers believe that the brain changes resulting from malnutrition might affect how neurons respond to psychoactive drugs, contributing to the limited effectiveness of medication trials.
Patients with anorexia have shown little improvement when treated with medication for other conditions like anxiety. It seems that malnourished brains do not respond well to psychoactive medication, and the absence of crucial proteins and fats necessary for brain function may affect the brain’s metabolism of drugs.
Currently, non-pharmaceutical interventions such as nutrition counseling and psychotherapy are the main methods employed to treat anorexia. However, even with these interventions, anorexia has a higher relapse rate compared to bulimia and binge-eating disorder. Patients with anorexia often exhibit ambivalence toward behavior change, which can make treatment challenging.
Research is ongoing to find substances that can effectively help anorexia patients. Leptin, a human hormone, is being studied, and early research into psychedelics like ketamine, psilocybin, and ayahuasca has shown potential in relieving some symptoms. However, randomized controlled trials are still needed to determine their effectiveness. Pharmaceutical companies have shown limited interest in testing treatments for anorexia, most likely due to the high mortality rate of the disorder. Additionally, research on eating disorders, in general, is underfunded.
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