Anorexia nervosa medical therapy

Anorexia nervosa Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Anorexia Nervosa from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Anorexia nervosa medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Anorexia nervosa medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Anorexia nervosa medical therapy

CDC on Anorexia nervosa medical therapy

Anorexia nervosa medical therapy in the news

Blogs on Anorexia nervosa medical therapy

Directions to Hospitals Treating Anorexia nervosa

Risk calculators and risk factors for Anorexia nervosa medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Joseph Nasr, M.D.[2]

## Overview

[edit | edit source]

The primary medical priority in anorexia nervosa is nutritional rehabilitation and weight restoration, particularly in individuals with medical instability. Treatment is best delivered through a multidisciplinary approach, involving physicians, psychiatrists, psychologists, dietitians, and other mental health professionals.[1][2]

Hospitalization is indicated for patients with severe malnutrition, cardiovascular instability, electrolyte abnormalities, or high psychiatric risk. In some cases, involuntary treatment under mental health legislation may be required to prevent life-threatening complications.[1][2]

## Nutritional Rehabilitation and Level of Care

[edit | edit source]

* Weight restoration is the cornerstone of treatment
* Medically stable patients may be treated as outpatients
* Inpatient or residential care is required for:
* Severe bradycardia or hypotension
* Electrolyte disturbances
* Rapid weight loss
* Suicidality or inability to eat safely[1][2]

## Psychotherapy

[edit | edit source]

Psychotherapy is an essential component of treatment and is associated with:

* Weight restoration
* Return of menses in females
* Improved psychological and social functioning[1][3]

No single psychotherapy modality has demonstrated clear superiority in adults. In adolescents, family-based treatment (Maudsley model) is strongly supported and is associated with sustained improvement.[1]

## Pharmacologic Therapy

[edit | edit source]

### General Principles

[edit | edit source]

There are no medications with proven efficacy as primary treatment for anorexia nervosa. Pharmacologic therapy plays a limited, adjunctive role and should not replace nutritional rehabilitation or psychotherapy.[1][2]

### Antidepressants

[edit | edit source]

* Selective serotonin reuptake inhibitors (SSRIs) and other antidepressants:
* Do not improve weight restoration
* Do not treat core anorexia nervosa symptoms in underweight patients[1][4]
* May be considered after partial weight restoration to treat:
* Comorbid depression
* Anxiety disorders
* Obsessive-compulsive disorder[1][2]

### Antipsychotic Medications

[edit | edit source]

* Olanzapine may be considered as adjunctive therapy:
* Associated with modest increases in weight gain
* May reduce anxiety and cognitive rigidity related to eating[1][4][5]
* Olanzapine is not effective as monotherapy and should be used selectively

### Hormonal Therapy

[edit | edit source]

* Oral estrogen therapy is not recommended:
* Does not improve bone mineral density
* Masks amenorrhea[1]
* Hormonal therapy does not treat anorexia nervosa itself

## Cardiac Arrhythmia Risk and Guideline Considerations

[edit | edit source]

> Although earlier cardiology guidelines explicitly addressed anorexia nervosa and severe dieting as risk states for ventricular arrhythmias, more recent ventricular arrhythmia guidelines incorporate these risks under the broader framework of reversible metabolic and systemic causes of arrhythmia. Modern ACC/AHA/HRS and ESC guidelines emphasize correction of underlying abnormalities such as electrolyte disturbances, starvation, bradycardia, and QT prolongation, rather than disease-specific recommendations for eating disorders. Management of life-threatening ventricular arrhythmias in patients with anorexia nervosa follows standard arrhythmia treatment principles, with careful consideration of reversibility, nutritional rehabilitation, and overall prognosis before device implantation.

### 2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death - Obesity, Dieting, and Anorexia (DO NOT EDIT) [6]

[edit | edit source]

Class I

"1. Life-threatening ventricular arrhythmias in patients with obesity, anorexia, or when dieting should be treated in the same manner that such arrhythmias are treated in patients with other diseases, including ICD and pacemaker implantation as required. Patients receiving ICD implantation should be receiving chronic optimal medical therapy and have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: C) "
Class III

"1. Prolonged, unbalanced, very low calorie, semistarvation diets are not recommended; they may be harmful and provoke life-threatening ventricular arrhythmias. (Level of Evidence: C)"
Class IIa

"1. Programmed weight reduction in obesity and carefully controlled re-feeding in anorexia can effectively reduce the risk of ventricular arrhythmias and SCD. (Level of Evidence: C)"

## References

[edit | edit source]

1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 SøebyM, Gribsholt SB, Clausen L, Richelsen B. Fracture risk in patients with anorexia nervosa over a 40-year period. J Bone Miner Res. 2023;38(11): 1586-1593. doi:10.1002/jbmr.4901
2. ↑ 2.0 2.1 2.2 2.3 2.4 American Psychiatric Association. Practice Guideline for the Treatment of Patients With Eating Disorders. 4th ed. American Psychiatric Association Publishing; 2023.
3. ↑ Solmi M,Wade TD, Byrne S, et al. Comparative efficacy and acceptability of psychological interventions for the treatment of adult outpatients with anorexia nervosa: a systematic review and network meta-analysis. Lancet Psychiatry. 2021;8 (3):215-224. doi:10.1016/S2215-0366(20)30566-6
4. ↑ 4.0 4.1 Fornaro M, Mondin AM, Billeci M, et al. Psychopharmacology of eating disorders: systematic review and meta-analysis of randomized controlled trials. J Affect Disord. 2023;338:526-545. doi:10.1016/j.jad.2023.06.068
5. ↑ Attia E, Steinglass JE,Walsh BT, et al. Olanzapine versus placebo in adult outpatients with anorexia nervosa: a randomized clinical trial. Am J Psychiatry. 2019;176(6):449-456. doi:10.1176/appi. ajp.2018.18101125
6. ↑ Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (10): e385–484. doi:10.1161/CIRCULATIONAHA.106.178233. PMID 16935995.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)

Template:WH Template:WS