pubmed.ncbi.nlm.nih.gov

Pharmacotherapy, alternative and adjunctive therapies for eating disorders: findings from a rapid review - PubMed

  • ️Sun Jan 01 2023

Review

Pharmacotherapy, alternative and adjunctive therapies for eating disorders: findings from a rapid review

Sarah-Catherine Rodan et al. J Eat Disord. 2023.

Abstract

Background: The current review broadly summarises the evidence base for pharmacotherapies and adjunctive and alternative therapies in the treatment of eating disorders and disordered eating.

Methods: This paper forms part of a Rapid Review series examining the evidence base in the field of eating disorders. This was conducted to inform the Australian National Eating Disorder Research and Translation Strategy 2021-2030. ScienceDirect, PubMed and Ovid/Medline were searched for included studies published between 2009 and 2021 in English. High-level evidence such as meta-analyses, large population studies and randomised control trials were prioritised, and grey literature excluded. Data from included studies relating to pharmacotherapy, and to adjunctive and alternative therapies in eating disorders, were synthesised and disseminated in the current review.

Results: A total of 121 studies were identified, relating to pharmacotherapy (n = 90), adjunctive therapies (n = 21) and alternative therapies (n = 22). Some of the identified studies involved combinations of the above (e.g. adjunctive pharmacotherapy). Evidence of efficacy of interventions across all three categories was very limited with few relevant high quality clinical trials. There was a particular scarcity of evidence around effective treatments for anorexia nervosa (AN). With treatment of bulimia nervosa (BN), fluoxetine has exhibited some efficacy leading to regulatory approval in some countries. With binge eating disorder (BED), recent evidence supports the use of lisdexamfetamine. Neurostimulation interventions show some emerging efficacy in the treatment of AN, BN and BED but some, such as deep brain stimulation can be highly invasive.

Conclusion: Despite widespread use of medications, this Rapid Review has identified a lack of effective medications and adjunctive and alternative therapies in the treatment of EDs. An intensification of high-quality clinical trial activity and drug discovery innovation are required to better assist patients suffering from EDs.

Keywords: Adjunctive therapy; Alternative therapy; Anorexia nervosa; Binge eating disorder; Bulimia nervosa; Eating disorders; Pharmacotherapy.

Plain language summary

Eating disorders have the highest mortality rates and treatment costs of all mental health conditions. This rapid review summarises the evidence around the use of medications and various alternative therapies in the treatment of eating disorders. The review highlights a lack of effective interventions for the treatment of anorexia nervosa with an urgent need to trial new treatments for this condition. Two medications show some efficacy in treating other eating disorders: the antidepressant drug fluoxetine for the treatment of bulimia nervosa, and the stimulant drug lisdexamfetamine for binge eating disorder. There is some positive evidence emerging from novel therapies that involve brain stimulation technologies. Overall, more high-quality research is needed to discover and develop new medications, and other alternative therapies, to better assist patients with eating disorders.

© 2023. The Author(s).

PubMed Disclaimer

Conflict of interest statement

ST receives royalties from Hogrefe and Huber, McGraw Hill and Taylor and Francis for published books/book chapters. He has received honoraria from the Takeda Group of Companies for consultative work, public speaking engagements and commissioned reports. He has chaired their Clinical Advisory Committee for Binge Eating Disorder. He is the Editor in Chief of the Journal of Eating Disorders. ST is a committee member of the National Eating Disorders Collaboration as well as the Technical Advisory Group for Eating Disorders. AL undertook work on this Rapid Review while employed by HMA. SM is a guest editor of the special issue “Improving the future by understanding the present: evidence reviews for the field of eating disorders.”

Figures

Fig. 1
Fig. 1

Schematic showing pharmacotherapies that have been investigated in the treatment of the three core EDs (AN, BN and BED) and their conceptual modes of action. This includes the hedonic (cannabinoid, opioid and dopamine-related), self-regulatory (serotonin and glutamate-related), homeostatic (histamine, CART and neuropeptide Y related) and peripheral metabolic (leptin, ghrelin, insulin GLP-1) systems. Source: Himmerich & Treasure (2018) ‘Psychopharmacological advances in eating disorders’

Similar articles

Cited by

References

    1. Beumont PJ, Touyz SW. What kind of illness is anorexia nervosa? Eur Child Adolesc Psychiatry. 2003;12(1):i20–i24. - PubMed
    1. American Psychiatric Association, A. and A.P. Association, Diagnostic and statistical manual of mental disorders: DSM-5. 2013, Washington, DC: American psychiatric association.
    1. Treasure J, et al. New treatment approaches for severe and enduring eating disorders. Physiol Behav. 2015;152:456–465. doi: 10.1016/j.physbeh.2015.06.007. - DOI - PubMed
    1. Pennesi JL, Wade TD. A systematic review of the existing models of disordered eating: do they inform the development of effective interventions? Clin Psychol Rev. 2016;43:175–192. doi: 10.1016/j.cpr.2015.12.004. - DOI - PubMed
    1. Himmerich H, Treasure J. Psychopharmacological advances in eating disorders. Expert Rev Clin Pharmacol. 2018;11(1):95–108. doi: 10.1080/17512433.2018.1383895. - DOI - PubMed

Publication types

LinkOut - more resources