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Evidence summaries

Antidepressants for Anorexia Nervosa

Antidepressants appear to be ineffective in the treatment of anorexia nervosa. Level of evidence: "B"

A Cochrane review [Abstract] 1 included seven studies with a total of 190 subjects. Four placebo-controlled trials (fluoxetine 1 trial, n=31; amitriptyline 2 trials, n=73; clomipramine 1 trial, n=16) did not find evidence that antidepressants would improve weight gain, eating disorder or associated psychopathology. Meta-analysis of data was not possible for most outcomes. Antidepressant versus antidepressant comparisons favoured amineptine and nortriptyline over fluoxetine but these isolated findings cannot be conceived as evidence of efficacy of a specific drug. Comment: The quality of evidence was lowered by sparse data and serious limitations in study quality.

In another randomized, double-blind, placebo-controlled trial 2, published after the updating of the Cochrane review, 93 patients with anorexia nervosa were assigned either to fluoxetine (n=49) or placebo following weight restoration to regain minimum body mass index of 19.0. The patients were treated for up to 1 year as outpatients in double-blind fashion. All patients also received individual cognitive behavioral therapy. Similar percentages of patients in both groups maintained a body mass index of at least 18.5 and remained in the study for 52 weeks (fluoxetine, 26.5%; placebo, 31.5%; p=0.57). There was no significant difference between fluoxetine and placebo in time-to-relapse (Cox proportional hazards analysis: hazard ratio 1.12; 95% CI, 0.65-2.01; p=0.64).

A topic in Clinical Evidence 2 summarizes the results two trials with a total of 115 subjects. The trials found no difference between tricyclic antidepressants and placebo in global response or rate of weight gain. Adverse effect were more common with antidepressants. Comment: The grade of evidence is downgraded by sparse data.

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    References

    • Claudino AM, Hay P, Lima MS, Bacaltchuk J, Schmidt U, Treasure J. Antidepressants for anorexia nervosa. Cochrane Database Syst Rev 2006 Jan 25;(1):CD004365. [PubMed]
    • Walsh BT, Kaplan AS, Attia E, Olmsted M, Parides M, Carter JC, Pike KM, Devlin MJ, Woodside B, Roberto CA, Rockert W. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. JAMA 2006 Jun 14;295(22):2605-12. [PubMed]
    • Treasure J, Schmid U. What are the effects of treatments in anorexia nervosa. Clinical Evidence 2005;13:1151-1152.

Primary/Secondary Keywords