NEUROBIOLOGICAL AND PSYCHOPHARMACOLOGICAL BASIS IN THE THERAPY OF BULIMIA AND ANOREXIA

1. Eating disorders can be found in several psychiatric pathologies: s chizophrenia, delusional disorder (somatic type), bipolar disorders, m ajor depressive disorder, borderline personality disorder, generalized anxiety disorder, body dysmorphic disorder, somatization disorder and conversion disorder. 2. Although their clinical features have been de fined, relatively little is known about the role of neurobiological pa tterns in the pathogenesis of these disorders. Several CNS neurotransm itters and neuromodulators are involved in the regulation of eating be havior in animals and have been implicated in symptoms such as depress ion and anxiety often observed in patients with eating disorders. The authors will review some studies on NA, DA, 5-HT, beta-endorphines, CR H, VP, OT, CCK, NPY and PYY envolved in eating disorders. Furthermore, we will highlight some of the studies on drug therapy of eating disor ders taking into account the effects of these agents on neurotransmitt ers and neuromodulators.3. Antidepressant drugs have long been used fo r anorexia nervosa and bulimia, these disorders been claimed to be aff ective equivalent. Antidepressant agents seem to be effective in reduc ing the frequency of binge-eating episodes, purging behavior and depre ssive symptomatology. It is notable that antidepressant agents have be en proved to be effective in patients with chronic bulimic symptoms, e ven in cases persisting for many years and in patients who had repeate dly failed courses of alternative therapeutic approaches. In ail of th e positive studies, antidepressant agents appeared effective even in b ulimic subjects who did not display concomitant depression. 4. Few con trolled studies on use of medications for anorexia nervosa have been p ublished. Central serotonergic receptor-blocking compounds such as cyp roheptadine cause marked increase in appetite and body weigh. Zinc sup plementation or cisapride could be a therapeutic option in addition to psychological and other approaches in anorexia nervosa. 5. There is n o therapy as yet which is fully effective in alimentary disorders. Psy chotropic drugs give some relief from symptoms, but they cannot cure t he disorders. An integrated approach, either pharmacological or psycho logical, is still recommendable.