Controlled Trial: Antidepressants Useless to Treat Anorexia–Risk: 1 of 49 Attempted Suicide

Their findings overturn the legitimacy of prescribing these drugs for eating disorders: the drugs don’t work when compared to placebo.

Indeed, the use of Prozac, a drug known to reduce food intake–which some doctors have misprescribed it for weight loss–to treat someone who is starving to death, defies logic and common sense. However, as every medical doctor knows, the purveyors of psychotropic drugs have never been held to scientific standards.

In this trial, Prozac (fluoxetine) was tested in 49 young women against a placebo given to 40 women.

The study authors report: "A 17-year-old patient assigned to fluoxetine made a suicide attempt during the study"–none on placebo.

This cofirms the accuracy of FDA’s warning that antidepressants pose a 1 in 50 risk of suicidality for children and adolescents.

Indeed in this study, the rate of actual ATTEMPTED SUICDE–reaquiring hospitalization–is one in 49.

The authors conclude: "These data imply that therapeutic efforts would be better devoted to psychological and behavioral interventions for which there is some, albeit modest, evidence of efficacy."

See, Timothy Walsh, et al, Fluoxetine After Weight Restoration in Anorexia Nervosa A Randomized Controlled Trial, published in the Journal of the American Medical Assocition, June 14, 2006-Vol 295, No. 22 2605-2612.

The New York Times report (below) quotes Dr. Walter Kaye of Pittsburgh University–a major promoter of antidepressants for eating disorders–who seems oblivious to the dagners of these drugs when he suggests that even if the drugs have proven worthless as a treatment for anorexia, they should be used because he "thinks" so. His reasoning defies the Hippocratic Oath: "Above all, do no harm."

"For patients like these, who don’t have access to psychological treatments, who have a choice between medication or nothing at all, I think the medication could help," Dr. Kaye said.

That’s irresponsible, faith-based medicine–having more in common with voodooo than evidence-based medicine.

Dr. Kaye’s speculative flights of imagination–in the absence of scientific evidence–were transcribed in a NewsWeek cover story:

"scientists are tracking important differences in the brain chemistry of anorexics. Using brain scans, researchers at the University of Pittsburgh led by professor of psychiatry Dr. Walter Kaye, discovered that the level of serotonin activity in the brains of anorexics is abnormally high. These pumped-up levels of hormone may be linked to feelings of anxiety and obsessional thinking, classic traits of anorexia. Kaye hypothesizes that anorexics use starvation as a mode of self-medication. How? Starvation prevents tryptophane, an essential amino acid that produces serotonin, from getting into the brain. By eating less, anorexics reduce the serotonin activity in their brains, says Kaye, "creating a sense of calm," even as they are about to die from malnutrition.

See: http://www.msnbc.msn.com/id/10219756/site/newsweek/page/2/

Bellow is an abstract of a recent scientific report published in the Archives of Pharmaceutical Research, confirming consistent decades old animal research findingts:

SSRIs suppress appetite. These scinetists found evidence suggesting that antidepressants may actually induce anorexia!!

Arch Pharm Res. 2005 Jun;28(6):716-21.

Role of neuropeptide Y and proopiomelanocortin in fluoxetine-induced anorexia.

Myung CS , Kim BT, Choi SH , Song GY , Lee SY Jahng JW

Laboratory in Pharmacology, Chungnam National University College of

Pharmacy, Daejeon 305-764, Korea. cm8r@cnu.ac.kr

Fluoxetine is an anorexic agent known to reduce food intake and weight gain.

However, the molecular mechanism by which fluoxetine induces anorexia has

not been well-established. We examined mRNA expression levels of

neuropeptide Y (NPY) and proopiomelanocortin (POMC) in the brain regions of

rats using RT-PCR and in situ hybridization techniques after 2 weeks of

administering fluoxetine daily.

Fluoxetine persistently suppressed food intake and weight gain during the

experimental period. The pair-fed group confirmed that the reduction in body

weight in the fluoxetine treated rats resulted primarily from decreased food

intake. RT-PCR analyses showed that mRNA expression levels of both NPY and

POMC were markedly reduced by fluoxetine treatment in all parts of the brain

examined, including the hypothalamus. POMC mRNA in situ signals were

significantly decreased, NPY levels tended to increase in the arcuate

nucleus (ARC) of fluoxetine treated rats (compared to the vehicle controls).

In the pair-fed group, NPY mRNA levels did not change, but the POMC levels

decreased (compared with the vehicle controls).

These results reveal that the chronic administration of fluoxetine decreases

expression levels in both NPY and POMC in the brain, and suggests that

fluoxetine-induced anorexia may not be mediated by changes in the ARC

expression of either NPY or POMC.

It is possible that a fluoxetine raised level of 5-HT play an inhibitory

role in the orectic action caused by a reduced expression of ARC POMC

(alpha-MSH).

 

Contact: Vera Hassner Sharav

veracare@ahrp.org <mailto:veracare@ahrp.org>

 

http://www.nytimes.com/2006/06/14/health/14prozac.html

Study Sees No Gain in Using Antidepressant to Treat Anorexia

By BENEDICT CAREY

Published: June 14, 2006

One of the most widely used treatments for the eating disorder anorexia nervosa, the antidepressant  Prozac, works no better than dummy pills in preventing recurrence in young women who have recovered from it, researchers are reporting today.

Fluoxetine After Weight Restoration in Anorexia Nervosa (JAMA) The study, the most rigorous to date to test the use of medication for anorexia, should alter treatment for an illness that is often devastatingly chronic and that has a higher mortality than any other psychiatric disorder, experts said.

Fewer than a third of the study’s participants, who also received regular psychotherapy, remained healthy for a year or more, whether they received drug treatment or not, the study found.

An estimated 1 percent of Americans, or about three million people, mostly young women, will at some point suffer from the self-starvation and obsessive anxiety about weight that characterize anorexia, and surveys find that about two-thirds of them receive treatment with Prozac or similar antidepressants, which are considered generally interchangeable.

Research suggests that the drugs can be useful in helping people recover from bulimia nervosa, an eating disorder involving bingeing and purging that causes less dramatic weight loss than anorexia. But the new findings put to rest hopes from earlier work that these benefits might carry over to anorexia, experts said.

"Physicians who are trying to help people with anorexia remain symptom-free should not count on getting substantial benefits from antidepressants," said Dr. B. Timothy Walsh, the lead author of the study, who is director of eating disorders research at the New York State Psychiatric Institute at the Columbia University Medical Center

"Doctors should be looking at other things, like good psychological treatments," Dr. Walsh said.

In the study, appearing in The Journal of the American Medical Association, researchers from Columbia and the University of Toronto monitored 93 women, ages 16 to 45, who, after receiving intensive psychotherapy, gained enough weight to fall into the normal range. Half the group then received daily doses of Prozac, and the other half took dummy pills. All of them continued in weekly psychotherapy, where they practiced techniques to examine and diffuse irrational assumptions about weight and body image.

After a year, 26 percent of those on Prozac and 31 percent of those taking placebo pills remained in a healthy weight range, the study found. The differences between the two groups, in weight and on measures of beliefs about food and weight gain, were not large enough to be significant.

"This study will change practice, beginning with the community of doctors who specialize in eating disorders and spreading more broadly" to other doctors, said Dr. Scott Crow, a psychiatrist at the University of Minnesota , who wrote an editorial accompanying the study.

Dr. Walter Kaye, a professor of psychiatry at the University of Pittsburgh said the new findings should not rule out the use of antidepressant treatment altogether. In 2001, Dr. Kaye published a small study suggesting that Prozac did help some young women who had recovered from anorexia keep on weight. They were women who did not binge – they ate very little – and did not receive psychotherapy.

"For patients like these, who don’t have access to psychological treatments, who have a choice between medication or nothing at all, I think the medication could help," Dr. Kaye said.

All agree that the new findings emphasize the importance of thinking creatively about treatment. The best psychotherapy available, said Dr. Crow, helps only about a third of anorexia patients recover. Another third learn to moderate and live with their aversions to food, while the rest develop a chronic disorder, putting them at high risk for suicide or death from starvation.

Researchers are experimenting with several new therapeutic techniques. One is a type of family therapy for adolescents, in which parents take charge of all meals. The parents decide how much their daughter or son should eat – based on specific guidelines – and reward good behavior, if appropriate.

Several studies suggest that this approach can lead to sustained recovery in some teenagers. Some evidence suggests that this kind of close monitoring by a therapist can also help adults with the disorder.

Psychiatrists have experimented, so far in vain, with a wide variety of drugs for treatment, including antipsychotic medications, so-called mood-stabilizing drugs like lithium and agents similar to the active ingredients in marijuana.

"It’s disappointing, really," Dr. Walsh said. "We would like to do better. We need to do better."

 

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