ADVANCES IN THE TREATMENT OF ANOREXIA-NERVOSA AND BULIMIA-NERVOSA

During the last decade, much investigation into possible pharmacothera py for eating disorders has been undertaken, especially for bulimia ne rvosa. Intensive hospital treatment compromising a combination of indi vidual, group and family therapies with or without adjunctive pharmaco logical treatments are usually offered in anorexia nervosa. Osteoporos is and delayed gastric emptying are 2 medical complications that shoul d be addressed as early as possible in the course of the disorder. Alt hough not yet confirmed in controlled clinical trials, there is prelim inary support for the use of hormone replacement therapy for anorexic patients with amenorrhoea. The short term use of prokinetic agents suc h as cisapride or domperidone may assist in the refeeding process. Des pite several controlled clinical trials involving antipsychotic and an tidepressant drugs, there is no pharmacological agent that has demonst rated superiority in enhancing the rate of bodyweight gain. Recently, uncontrolled and unblinded trials with fluoxetine in anorexia nervosa have offered promising results. However, further double-blind controll ed evaluation is necessary to properly evaluate the role of fluoxetine or other selective serotonin (5-hydroxy-tryptamine; 5-HT) reuptake in hibitors (SSRIs) in treating anorexia nervosa. In contrast to the limi ted literature on the treatment of anorexia nervosa, there have been a series of controlled clinical trials investigating treatments for bul imia nervosa. These have involving different forms of psychotherapy, b oth individual and group formats, or pharmacotherapy. Several investig ators have also reported on the benefits of combining drug and psychol ogical treatment in comparison to either approach on its own. SSRIs, m onoamine oxidase inhibitors and tricyclic antidepressants have all bee n shown to offer symptomatic improvement in trials lasting between 6 a nd 24 weeks. A 24-week clinical trial of desipramine combined with ind ividual cognitive therapy produced the best outcome. It is hoped that over time, with reduced cultural pressures to diet and with more empha sis on early detection of those individuals at risk of developing eati ng disorders, the occurrence and complications of these disorders will be reduced. Treatment research in the next decade will hopefully incl ude clinical and biological predictors of response, meaningful long te rm outcome assessment, and novel interventions that will minimise the significant morbidity and mortality of these illnesses.