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Antidepressant Does Not Reduce Risk Of Relapse Among Patients With Anorexia Nervosa

Science Update

An NIMH-funded study has concluded that the antidepressant medication fluoxetine (Prozac) is no more effective than placebo in preventing relapse among patients with anorexia nervosa who had achieved a healthy weight during inpatient or day-program treatment. The study appears in the June 14 issue of the Journal of the American Medical Association.

The large trial followed 93 participants in New York and Toronto who had been diagnosed with anorexia nervosa and had achieved a healthy weight following intensive treatment. One week before discharge, the patients were randomly assigned to either fluoxetine or placebo, in a double-blind trial. After discharge from the hospital, in addition to the medication, the patients received 50 weekly sessions of a form of psychotherapy designed specifically to reduce the likelihood of relapse among patients with anorexia nervosa.

After 52 weeks, 45 percent of those in the placebo group did not relapse; 43 percent of the fluoxetine group did not relapse. In addition, the number of patients in each group who maintained a medically healthy weight and remained in the study for its full duration was similar—26 percent of the fluoxetine group and 31 percent of the placebo group.

The trial is particularly relevant because among patients with anorexia nervosa who achieve a healthy weight during initial hospitalization, 30 to 50 percent experience a relapse and may need to be hospitalized again. Very often, patients with anorexia nervosa have coexisting psychiatric symptoms of obsessive-compulsive disorder, depression or anxiety, and are prescribed antidepressant medication. Yet, the study showed that antidepressant medication does not provide a substantial benefit for treating anorexia nervosa and maintaining recovery.

The authors suggest that more efforts should be devoted to improving psychological and behavioral treatments, which have shown to be modestly effective in treating patients with anorexia nervosa. They also urge further research into developing more innovative medications to treat this debilitating disorder.

B. Timothy Walsh, MD, of Columbia University/New York Psychiatric Institute, led the study. Other study authors are Allan S. Kaplan, MD, FRCPC; Evelyn Attia, MD; Marion Olmsted, PhD; Michael Parides, PhD; Jacqueline C. Carter, PhD; Kathleen M. Pike, PhD; Michael J. Devlin, MD; Blake Woodside, MD, FRCPC; Christina A. Roberto, BA; and Wendi Rockert, MEd.

Walsh B, et al. Fluoxetine after weight restoration in anorexia nervosa, a randomized control trial . Journal of the American Medical Association, 2006 Jun 14; 295(22): 2605-2612.