Study Sees No Gain in Using Antidepressant to Treat Anorexia

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The New York Times

June 14, 2006 Wednesday

Study Sees No Gain in Using Antidepressant to Treat Anorexia

By BENEDICT CAREY

One of the most widely used treatments for the eating disorder anorexia nervosa,

the antidepressant Prozac, works no better than dummy pills in preventing

recurrence in young women who have recovered from it, researchers are reporting

today.

The study, the most rigorous to date to test the use of medication for anorexia,

should alter treatment for an illness that is often devastatingly chronic and

that has a higher mortality than any other psychiatric disorder, experts said.

Fewer than a third of the study's participants, who also received regular

psychotherapy, remained healthy for a year or more, whether they received drug

treatment or not, the study found.

An estimated 1 percent of Americans, or about three million people, mostly young

women, will at some point suffer from the self-starvation and obsessive anxiety

about weight that characterize anorexia, and surveys find that about two-thirds

of them receive treatment with Prozac or similar antidepressants, which are

considered generally interchangeable.

Research suggests that the drugs can be useful in helping people recover from

bulimia nervosa, an eating disorder involving bingeing and purging that causes

less dramatic weight loss than anorexia. But the new findings put to rest hopes

from earlier work that these benefits might carry over to anorexia, experts

said.

''Physicians who are trying to help people with anorexia remain symptom-free

should not count on getting substantial benefits from antidepressants,'' said

Dr. B. Walsh, the lead author of the study, who is director of eating

disorders research at the New York State Psychiatric Institute at the Columbia

University Medical Center.

''Doctors should be looking at other things, like good psychological

treatments,'' Dr. Walsh said.

In the study, appearing in The Journal of the American Medical Association,

researchers from Columbia and the University of Toronto monitored 93 women, ages

16 to 45, who, after receiving intensive psychotherapy, gained enough weight to

fall into the normal range. Half the group then received daily doses of Prozac,

and the other half took dummy pills. All of them continued in weekly

psychotherapy, where they practiced techniques to examine and diffuse irrational

assumptions about weight and body image.

After a year, 26 percent of those on Prozac and 31 percent of those taking

placebo pills remained in a healthy weight range, the study found. The

differences between the two groups, in weight and on measures of beliefs about

food and weight gain, were not large enough to be significant.

''This study will change practice, beginning with the community of doctors who

specialize in eating disorders and spreading more broadly'' to other doctors,

said Dr. Crow, a psychiatrist at the University of Minnesota, who wrote an

editorial accompanying the study.

Dr. Walter Kaye, a professor of psychiatry at the University of Pittsburgh, said

the new findings should not rule out the use of antidepressant treatment

altogether. In 2001, Dr. Kaye published a small study suggesting that Prozac did

help some young women who had recovered from anorexia keep on weight. They were

women who did not binge -- they ate very little -- and did not receive

psychotherapy.

''For patients like these, who don't have access to psychological treatments,

who have a choice between medication or nothing at all, I think the medication

could help,'' Dr. Kaye said.

All agree that the new findings emphasize the importance of thinking creatively

about treatment. The best psychotherapy available, said Dr. Crow, helps only

about a third of anorexia patients recover. Another third learn to moderate and

live with their aversions to food, while the rest develop a chronic disorder,

putting them at high risk for suicide or death from starvation.

Researchers are experimenting with several new therapeutic techniques. One is a

type of family therapy for adolescents, in which parents take charge of all

meals. The parents decide how much their daughter or son should eat -- based on

specific guidelines -- and reward good behavior, if appropriate. Several studies

suggest that this approach can lead to sustained recovery in some teenagers.

Some evidence suggests that this kind of close monitoring by a therapist can

also help adults with the disorder.

Psychiatrists have experimented, so far in vain, with a wide variety of drugs

for treatment, including antipsychotic medications, so-called mood-stabilizing

drugs like lithium and agents similar to the active ingredients in marijuana.

''It's disappointing, really,'' Dr. Walsh said. ''We would like to do better. We

need to do better.''