Having a bad day in the office can come in different forms, but this one came in a slender frame. When she walked into the office, I was about to ask, "How old are you", when her matured facial features came through. She was 24 and looked barely 13. Anorexia nervosa is one of the major eating disorders and it startles the conscious of many exceedingly because they cannot understand why a young lady abhors eating when her thinness mimics a thin wrap of skin over a bony skeleton. While the cause is a convergence that involves multiple layers of factors that stretches between family, environmental and personal perception, the fear of eating in spite of severe malnutrition has had numerous treatment options thrown at it. But how effective are these measures.
Anorexia nervosa is often accompanied by depression or depressive symptoms. A chemical substance, Serotonin coordinates signal transfer in the brain that regulates appetite and mood. This has motivated the use of Antidepressants to combat Anorexia. While the drug Fluoxetine (Prozac, Sarafem), a class of drug referred to as Selective Serotonin Re-uptake Inhibitor has shown little positive prospect with no discernable difference in effect when compared with no treatment (placebo), more traditional agents such as Amitriptyline and Cryoheptadine have proven equally as ineffective. The main difference between Fluoxetine and Amitriptyline is that patients tend to hold on longer to the later in spite of the poor benefit profile.
Steroid hormones have been used to encourage weight gain for decades because of their anabolic properties. Testosterone delivered transdermally is helpful in encouraging weight gain when depression is associated with Anorexia. Other hormone, such as Growth hormone and Estrogen/Progesterone (Premarin and Provera) have been used but with inconsistent benefit. Nutritional supplements have not been left out, especially minerals. Zinc accelerates increases in the weight gain but the number of patients who stop medication is quite high.
Psychological intervention (Cognitive Behavioral, Family and Individual therapies) have been tried in different approaches, essentially to modify perception concerning the individual's opinion on weight. The only strong evidence for effectiveness relates to psychotherapy for adolescents.
Generally, effective therapies for Anorexia are scarce but what is certain is that managing patients with Anorexia Nervosa on medication alone is inappropriate because none of the drugs used for Anorexia have a significant impact on weight gain or the psychological features of the disorder. Although mood may improve with antidepressants, this outcome is not associated with improved weight gain. Moreover, medication treatment for Anorexia is associated with high dropout rates, suggesting that the currently available medications are not acceptable to individuals with this eating disorder.