Biological treatments for anorexia

What does the National Institute for Health and Care Excellence (NICE) say about biological treatments for anorexia?

It states that drugs should not be used as the main or only treatment for patients with AN. However, many patients with anorexia suffer for comorbid symptoms, including depression and anxiety. Drug therapy is generally effective at addressing these other symptoms.

What antidepressants are used to treat AN?

Selective Serotonin Reuptake Inhibitors (SSRI’s)

Example of an SSRI?

Fluoxetine

How are antidepressants / SSRI’s used to treat AN?

They block the reuptake of serotonin back into the pre synaptic neurone. This causes the levels of the neurotransmitter to increase in the synapse, so more serotonin is passed to the post synaptic neurone. An increase in serotonin binding is beneficial in maintenance of appetite and can help individuals to be less restrictive with their diet. Additionally, these drugs benefit patients who suffer with anxiety / depression as well as anorexia. The use of medication can reduce these symptoms so that they are less likely to drop out of psychosocial therapy programmes necessary to treat anorexia and prevent relapse.

What is a common antipsychotic used to treat AN?

Olanzapine

How are antipsychotics / olanzapine used to treat AN?

Olanzapine is an antagonist, thought to work by blocking D2/D3 receptors, stopping the absorption of dopamine and blocking 5-HT2A receptors for serotonin in neutral pathways within the brain. This helps to alter motivation and reward perception, additionally, reducing obsessive thoughts about food. This will limit the patient’s anxiety around mealtimes, in turn encouraging regular eating and helping the AN patient to recover. Olanzapine is also linked to increasing the production of ghrelin (hunger hormone), so taking this drug will induce appetite, resulting in weight gain as a side effect. This is useful as AN patients have a significantly low body weight for their age and sex.

What did Malina et al (2003) find?

Found that patients who took olanzapine reported lower levels of anxiety and less difficulty with eating

What are the strengths of biological treatments for CBT?

• Supporting evidence from Jensen and Mejhede

• It should work more quickly than therapy based treatments, eg- CBT

How are Jensen and Mejhede (2000) a strength of biological treatments?

Found supporting evidence to demonstrate the effectiveness of drug treatments for AN by looking at the case studies of 3 patients who had taken olanzapine. The patients all showed an increase in positive body image which was also more realistic as to what they actually looked like. Therefore, it seems that drug treatment can be an effective therapy for treating anorexia.

Why is the rate at which drug treatments work a strength of biological treatments?

Drug treatments work more quickly than therapy based treatments such as CBT. They can always work in conjunction to give the most effective treatment plan.

What are 3 weaknesses of biological treatment for AN?

• Small sample sizes (ONLY use when comparing to Jensen and Mejhede (2000))

• Not all research suggests it’s effective - Ferguson et al (1999)

• Side effects

What is a counterargument for Jensen and Mejhede’s (2000) evidence?

A small sample size was used, which can lead to questions about the reliability of the data since this evidence will be difficult to replicate. Therefore, it is difficult to make strong conclusions about the effectiveness of drug treatments.

Why is Ferguson et al (1999) a weakness of biological treatments?

Found evidence to suggest that drug treatment isn’t always effective at treating the disorder. Ferguson found that there was no significant difference between 24 patients given SSRIs compared to the 16 patients on the ward who weren’t given SSRIs in relation to body weight and anxiety. Therefore, the role of drugs in treating anorexia appears limited, likely because the drug focuses on the symptoms rather than the actual causes of AN.

Why are side effects a weakness of biological treatment for AN?

There are the dangers of side effects when taking medication. For example, with SSRIs there could be weight gain, numbness, little alcohol tolerance, dry mouth, headache, increased chances to type 2 diabetes, etc. This is a problem as it may lead to people with AN refusing to take medication, preventing them from overcoming the disorder.