CPG for Eating Disorders

In an RCT (Kaye, 2001; USA) 279 fluoxetine was compared to placebo in 39 adult femaleinpatients and outpatients with AN. Patients, before being discharged, received20mg/day of fluoxetine, which was adjusted to a maximum dose of 60mg/day at 52weeks. The group treated with fluoxetine presented significant increases in BMI anddecreases in depression, anxiety, obsessive-compulsive disorders and symptoms relatedwith eating disorders.In an RCT (Biederman, 1985; USA) 281 amitriptyline (175 mg/day) was compared toplacebo in 25 patients and outpatients (age: 11-17 years) with AN. There were nosignificant differences in symptoms related with eating disorders, behaviour or weightwhen compared to placebo.In an RCT (Halmi, 1986; USA) 282 amitriptyline (160 mg/day) was compared tocyproheptadine (appetite stimulant) (32 mg/day) and to placebo in 72 female inpatients(age: 13-36 years). In the group treated with cyproheptadine, daily calorie intake wassignificantly greater than in the placebo group. In the groups treated with amitriptylineand cyproheptadine, weight restoration increased in less days than the placebo group.Patients with nonbulimic AN obtained better results with cyproheptadine than withamitriptyline or placebo.RCT1+RCT1+RCT1+Summary of the EvidenceSRSE 311++CPG 30SRSE 311++SRSE 311++The literature that exists on pharmacological treatment of AN is scarce andinconclusive. Most RCTs are based on small samples and very few of themhave statistical value to support their conclusions. Many studies includepatients who are receiving other treatment, whether it is psychological orpharmacological. As far as cases studied, they include inpatients that laterreceive outpatient treatment, which prevents generalisation of results.There is evidence that indicates significant differences in weight increase by theend of multimode treatment with antidepressants when compared to placebo (4RCT; N=146;Attia, 1998 280 [fluoxetine]; Biederman, 1985 281 [amitriptyline];Halmi, 1986 282 [amitriptyline]; Lacey, 1980 283 [clomipramine]).There is insufficient evidence to determine that there are significant differencesbetween antidepressants (citalopram) and wait-list in weight gain by the end ofoutpatient treatment (1 RCT; N=26; Fassino, 2002) 284 .Tricyclic antidepressants can be associated with improvement of disorderssecondary to eating disorders. However, these results are no associated withweight increase.Recommendations(See recommendations 9.GPH.1. to 9.GPH.6.)139CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS