Pharmacological treatment of eating disorders

The treatment of eating disorders (ED) usually involves a multidisciplinary approach and pharmacotherapy is adjunctive to psychological and nutritional interventions. Psychotropic agents are prescribed for most patients with ED to treat both the comorbid conditions and ED core symptoms. Important progresses have occurred in the last years. We present an overview of the current evidences and future directions in the pharmacological treatment of anorexia nervosa, bulimia nervosa and binge eating disorder.O tratamento dos transtornos alimentares (TA) geralmente exige uma abordagem multidisciplinar em que a farmacoterapia é adjuvante de abordagens psicológicas e nutricionais. Psicotrópicos são indicados para a maioria dos pacientes com TA para tratar as comorbidades e também os sintomas chamados nucleares. Progressos importantes estão ocorrendo nos últimos anos. Este artigo apresenta uma revisão das evidências atuais e perspectivas futuras para o tratamento farmacológico da anorexia nervosa, bulimia nervosa e do transtorno da compulsão alimentar periódica.Universidade Federal do Rio de Janeiro Instituto de Psiquiatria Grupo de Obesidade e Transtornos AlimentaresInstituto Estadual de Diabetes e Endocrinologia do Rio de JaneiroUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Antidepressants versus placebo for the treatment of bulimia nervosa: a systematic review

Objective: the objective of this study was to valuate the effectiveness, tolerability and acceptability of various classes of antidepressants compared with placebo in the treatment of bulimia nervosa.Method: A meta-analysis including 16 randomised controlled trials and 1300 bulimic patients was performed. Dichotomous outcomes were analysed by calculating relative risks, and continuous outcomes by calculating effect sizes. Methodological quality, heterogeneity in the results and selective publication were assessed.Results: Short-term remission in bulimic symptoms was statistically more likely on antidepressants than placebo (Relative Risk = 0.88, 95% CI = 0.83-0.94, p < 0.0001). Drop-out rates were high but no statistical difference was found between treatment groups (34.6% and 31.4% for drug and placebo; RR = 1.03, 95% CI = 0.80-1.32, p = 0.8). No difference in efficacy could be demonstrated among different classes of antidepressants.Conclusions: the use of a single antidepressant agent was clinically effective for the treatment of bulimia nervosa when compared with placebo, with an overall greater remission rate and a higher rate of drop-outs. No differential effect regarding efficacy and tolerability among the various classes of antidepressants could be demonstrated.Universidade Federal de São Paulo, Paulista Sch Med, São Paulo, BrazilUniv Adelaide, Adelaide, SA, AustraliaUniversidade Federal de São Paulo, Paulista Sch Med, São Paulo, BrazilWeb of Scienc