Anti-depressants do not prevent relapse
Pill found to have same effect as placebo
Jun. 14, 2006. 01:00 AM
A common anti-depressant often prescribed for anorexia nervosa does not reduce patients' risk of relapsing or help them keep weight on once they have recovered, a new study shows.
Almost two-thirds of patients with the eating disorder, which primarily affects young women, are prescribed anti-depressants but the largest study of its kind, based in Toronto and New York, found they had no more effect than a placebo, said the study published yesterday in the Journal of the American Medical Association.
"This is not what we anticipated," said Dr. Allan S. Kaplan, head of the eating disorders program at Toronto General Hospital and co-author of the study. "We looked at the data upside down and we could not find the drug was any more effective than a dummy pill."
Anorexia is a very serious psychiatric disorder with a relapse rate of between 30 and 50 per cent in the first year and few treatment options, said Kaplan, who co-authored the study with Dr. Timothy Walsh of the New York State Psychiatric Institute.
Most anorexics who suffer from depression or anxiety problems are given anti-depressants, but no study has looked at their effectiveness, he said.
"Physicians are trying to do their best to help patients," he said, "and if the only tool you have in your toolbox is a hammer, you use a nail. This is a field desperate for new innovative treatment approaches."
The study looked at 93 girls and women between 16 and 45 in Toronto and New York who had recovered enough to be at normal weight. Half of them were then prescribed the selective serotonin reuptake inhibitor fluoxetine, initially marketed as Prozac, and the other half a placebo and both groups also received intensive psychotherapy.
After a year, 55 per cent of the placebo group and 57 per cent of the fluoxetine group had suffered a relapse.
People with other mood disorders improve on the drug, said Kaplan. "This tells you the brains of anorexics are different and we need to understand this condition better."
Anorexia has a mortality rate as high as any other psychiatric condition including schizophrenia. Most die of medical complications from not eating.
Research increasingly is indicating that anorexia is genetically based, he said, although society's emphasis on thinness plays a role.
"Genes load the gun and the environment pulls the trigger," he said. The onset of the disease is also spreading across age groups and is now commonly seen in pre-teens as well as women in their 30s and 40s.
While eating disorders are rising, most of that is in bulimia, where girls typically overeat and purge and do respond to treatment with anti-depressants, Kaplan said. About 80 per cent of bulimics recover with treatment, compared to 30 per cent of anorexics.
The study concludes that doctors would be better to use psychological and behavioural treatment for anorexics "for which there is some, albeit modest, evidence of efficacy," until better treatments are devised.