Can Antidepressants Treat Anorexia

Food as a problem

Professor Dr. Tanja Lassenbauer from the LWL University Clinic Hamm for child and adolescent psychiatry in Bochum. "In order to get well, patients have to do exactly what scares them most and try to avoid them at all - namely eat and gain weight."

Psychotherapy is the treatment method of choice. In the case of children and adolescents, the family should be involved in the therapy. The effectiveness of psychotropic drugs has not been proven in anorexia. The atypical antipsychotic olanzapine is sometimes used (temporarily and off-label), for example when there is an excessive urge to move around and a lot of brooding.

Without a clear understanding of the disease and the will to get well, doctors cannot help those affected in the long term. Even if they understand how threatening their condition is, recovery is difficult. A body schema disorder, i.e. the feeling of being (too) fat even when emaciated, has a disease-preserving effect.

"One goal of the therapy is to work on the negative, irrational beliefs about food and the body and to reward weight gain," explains the expert. "The shorter the duration of the illness, the better the chances of success in general." Factors such as a very low weight, comorbid mental disorders or strong family burdens are prognostically negative.

Weight gain is most important in managing most of the physical effects of being underweight. However, comorbid mental disorders usually require separate therapy. “There may even be a shift in symptoms. If the eating disorder improves, obsessive-compulsive symptoms, for example, can intensify, ”says the expert. This is due to the fact that underlying problems have not yet been dealt with and skills to cope with everyday life are lacking.

Relapse prophylaxis is necessary because patients often do not remain stable for long after outpatient or inpatient therapy. Only 50 to 75 percent recover in the long term. The disease becomes chronic in around 14 percent. Almost 15 percent die within 20 years. The mortality from anorexia nervosa is thus the highest among mental illnesses (1, 3, 9).

Bulimia: life between the refrigerator and the toilet

Data from America are available on the frequency of eating-vomiting addiction in adolescents between 13 and 18 years of age; after that, around 0.9 percent of girls and 0.3 percent of boys are affected (7). The patients are often inclined to be perfectionist, but at the same time suffer from strong self-doubt. The suppression of physical needs and a family environment in which there is a disturbed handling of conflicts can also promote the development of the disease.