Prozac Didn't Help Anorexics
Although Prozac (fluoxetine) is frequently used to treat anorexia, it does not prevent young women from recurrence of anorexia, according to a study published in the Journal of the American Medical Association (JAMA).
In the recent study by Timothy Walsh, MD, of New York State Psychiatric Institute, et al, more than half the participants receiving Prozac or placebo dropped out of the trial. Additionally, few remaining participants managed to keep their weight above dangerous levels.
In the US, anorexia affects slightly more than 1% of females and less than 1% of males.
The National Eating Disorders Association estimates that 10 million women and girls and 1 million men and boys have anorexia or bulimia. Bulimia is an eating disorder related to anorexia that is characterized by binge-eating; Prozac has been shown to offer some success in treating bulimia.
The study's results confirm the difficulty of treating anorexia nervosa, and the authors suggest that treatment methods other than antidepressants (e.g., counseling and behavior interventions) may offer greater benefit to patients.
Treating Anorexia
The results of Dr Walsh and colleagues' study should not be surprising, as anorexia nervosa "is considered one of the most treatment-resistant mental illnesses," according to Ellen Astrachan-Fletcher, a therapist and director of the Eating Disorders Clinic at the University of Illinois at Chicago.
The study follows a report made in April by the Agency for Healthcare Research and Quality (AHRQ), a division of the US Department of Health and Human Services. The AHRQ reviewed research literature and found that no medication effectively treats anorexia. Instead, the report said, some behavioral approaches may help to prevent relapse, and offer other limited benefits.
Clinical Trial
The study by Dr Walsh and colleagues took place over one year and included 93 women (aged 16-45 years) with anorexia. Prior to the study, participants had received psychiatric treatment and gained enough weight to be in the normal weight-range.
In total, about 27% of the 49 participants randomly assigned to Prozac maintained their normal weight and completed the study. In contrast, only 32% of the 44 participants receiving placebo did the same - however, these differences were statistically insignificant. In addition, 25 participants receiving Prozac and 28 participants receiving placebo dropped out because of weight loss or personal dissatisfaction with the treatment.
A 17-year-old participant receiving Prozac attempted suicide.
Although it is true that antidepressants have been linked with suicidal behavior in children, the researchers noted that anorexia is often accompanied by depression, and that anorexia has one of the highest suicide-rates of any psychiatric illness.
In their conclusion, the researchers wrote that the study's results suggest that "prescribing antidepressant medication is unlikely to provide substantial benefit for most patients with anorexia nervosa, either when they are underweight or immediately upon weight restoration."
They added, "These data imply that therapeutic efforts would be better devoted to psychological and behavioral interventions for which there is some, albeit modest, evidence of efficacy."
The study's lead author, Dr Timothy Walsh, and some of the other authors, have received funding from Eli Lilly and Co, manufacturer of Prozac, which provided the Prozac for this study. Research funding was courtesy of the National Institutes of Health.
Source: Prozac Didn't Help Anorexics, The Associated Press, June 13, 2006.
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