April 18, 2006 -- Antidepressants and other drugs are not effective treatments for anorexiaanorexia nervosa, but behavioral therapy can help prevent recovering anorexics from relapsing, according to findings from a review of eating disorder studies.
The treatment picture was somewhat more encouraging for bulimia and binge eating disorder. Specific drug therapies did appear to help patients with these eating disorders recover, and these patients were also more likely to benefit from interventions like behavioral therapy.
The review of the scientific literature was conducted by the Evidence-based Practice Center of the Agency for Healthcare Research and Quality (AHRQ) and the University of North Carolina, Chapel Hill.
Center program director Beth A. Collins Sharp, PhD, RN, says the failure to identify a clearly effective treatment strategy for anorexia is disappointing, but that doesn't mean that the available treatments don't work.
"The fact that we were not able to identify a panacea treatment makes it all the more important that patients work with their [health care] provider to find the approach that works for them," Sharp says.
"Most anorexia treatment continues to be done [in hospitals or treatment centers], where things can be individualized and monitored very closely. That is appropriate until we have evidence that can give us a better idea of which treatments work best."
Anorexia and bulimia are most common among female teenagers and young adults, but males and older people also suffer from the eating disorders.
Sharp and colleagues reviewed more than 40 studies examining anorexiaanorexia treatments and outcomes published from 1980 to 2005, along with more than 40 bulimia studies and more than 20 studies involving patients with binge eating disorder.
They concluded that:
- Neither medication nor medication combined with behavioral therapy showed evidence of being effective for helping anorexic patients recover from acute illness.
- Cognitive behavioral therapy (CBT), a form of psychotherapy that encourages patients to develop thinking patters to counteract unhealthy behaviors, did show some efficacy in helping adult anorexics avoid relapses once they achieved a normal weight. There was not enough evidence to determine if this therapy is effective earlier in treatment.
- Prozac was found to be useful for the treatment of bulimia in a short-term clinical trial. It is not clear from the available clinical evidence if other selective serotonin reuptake inhibitor (SSRI) antidepressants (such as Paxil or Zoloft) are also effective.
- Both group and individual CBT showed some evidence of effectiveness in the treatment of bulimia, binge eating, and purging. However, the optimum length of treatment and the best strategy for maintaining these health benefits were not clear from the studies.
- A specific type of family therapy that encourages parents to closely monitor and even choose the foods their child eats is showing promise in the treatment of anorexia in adolescents.
The Role of Parents
It may sound counterintuitive that having parents control what their child with anorexiaanorexia eats would help in recovery. Eating disorder treatment specialist Douglas Bunnell, PhD, acknowledges as much but adds that a growing number of studies suggest that it does. The approach is now considered the first-line treatment for children and teens with anorexia in Great Britain, where it was developed.
"Most therapists of my generation were trained to get the parents out of the mix as much as possible to avoid food wars with their children with eating disorders," he tells WebMD. "And it isn't as simple as the parents standing over the kid and nagging at them to eat. It is more sophisticated than that."
Bunnell, who is the immediate past president of the National Eating Disorders Association, says he is not surprised that the research review failed to identify a clearly superior approach to treating anorexia.
"We do not have a gold standard treatment," he says. "This report emphasizes the importance of individually tailored treatments drawn from a variety of disciplines."
It also highlights the fact that not enough research has been done to identify effective treatments for the eating disorder, he says.
Bunnell is clinical director of the Renfrew Center of Connecticut, a treatment center for women with eating disorders.
"The good news is that we understand this disorder much better than we did, but we have much to learn," he says. "Many, many patients recover with treatment. But there is no one definitive treatment for this complicated illness."