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Weight problems: medications to treat anorexia nervosa WEIGHT PROBLEMS: MEDICATIONS TO TREAT ANOREXIA NERVOSA
Some physicians have experimented with the use of hormones to treat anorexia. Insulin, for example, stimulates the metabolism of glucose (blood sugar). When the glucose level drops, it causes hypoglycemia (low blood sugar), which in turn triggers the appetite center in the brain to send out "feed me" signals. Thus, administration of insulin can stimulate appetite. This technique has largely fallen out of favor, however; among other things, as we have seen, lack of appetite is not the central problem in anorexia.
Recently there's been increasing interest in the use of cyproheptadine (sold under the brand name Periactin). This antihistamine is used to treat allergies and often causes mild weight gain as a side effect. Cyproheptadine is a serotonin antagonist - that is, it keeps serotonin from linking up with its receptors in the brain. By blocking serotonin, cyproheptadine lets the patient keep eating and thus gain weight. Studies seem to indicate that while cyproheptadine is a little better than a placebo (a "sugar pill") at relieving depression and at helping some hospitalized anorexics gain weight, the difference is generally not significant. Interestingly, this drug seems to produce some weight gain in non-bulimic anorexics, especially those who were born at lower weights than normal, but not in bulimic anorexics.
Because marijuana stimulates appetite, researchers wondered if marijuana's active ingredient, tetrahydrocannabinol, might work in anorexia. As it turned out, it didn't; not only did it produce no effect on weight, it also caused the patients to experience unpleasant moods.
Some medications might have use, not for the anorexia itself, but for some of the other physical problems associated with the disorder. For example, many patients relearning how to eat complain that the presence of food in their stomachs causes them to feel painful bloating. This is normal, even predictable, since their bodies have largely forgotten what it feels like to take in food. Anorexia disrupts many of the feedback loops regulating digestion. In some cases, use of medications to speed up emptying might help. Other such medications include bethanechol and metoclopramide. We don't yet have all the facts we need, however, to use these medications regularly as part of the medical treatment plan. Simethicone, a compound used to reduce gas and found in many over-the-counter digestive aids, can also help relieve the discomfort of re-feeding.
I've just given you several pages of information on drugs that have been investigated as possible treatments for anorexia. I must state again, however, that medications have not yet proved as helpful for anorexia as they have for bulimia. In my experience, no medication can substitute for a comprehensive program that addresses the many behavioral, cognitive, and family issues contributing to the illness. At best, drugs serve as a means of temporarily relieving a symptom, of taking some of the heat off the patient, so that we can begin to tackle the real problem.
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