Download PDF
Fortschr Neurol Psychiatr 2012; 80(1): 9-16
DOI: 10.1055/s-0031-1281845
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Pharmakotherapie von Anorexia nervosa und Bulimia nervosa: State of the Art

Pharmacotherapy for Anorexia Nervosa and Bulimia Nervosa
M. Greetfeld
1   Schön Klinik Roseneck, Prien am Chiemsee
,
U. Cuntz
1   Schön Klinik Roseneck, Prien am Chiemsee
,
U. Voderholzer
1   Schön Klinik Roseneck, Prien am Chiemsee
2   Abteilung Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg
› Author Affiliations
Further Information

Publication History

Publication Date:
12 December 2011 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Sowohl für Magersucht (Anorexia nervosa, AN) als auch für Bulimia nervosa (BN), ist Psychotherapie die Therapie der ersten Wahl. In der Praxis werden häufig auch medikamentöse Behandlungen durchgeführt. Der Kliniker steht bei der Auswahl der geeigneten Pharmakotherapie vor Schwierigkeiten (z. B. limitierter Zulassungsstatus von Medikamenten, schwer kalkulierbare Pharmakodynamik bei Untergewicht oder Purgingverhalten, Behandlungsbedarf komorbider Störungen). Die vorliegende Übersicht fasst den gegenwärtigen, leitlinienorientierten Kenntnisstand zur Pharmakotherapie von AN und BN zusammen. Grundsätzlich ist die Studienlage bei der AN noch unzureichend. Es existiert bislang kein Wirksamkeitsnachweis für Antidepressiva und atypische Neuroleptika hinsichtlich einer Gewichtszunahme; letztere können aber bei Gedankenkreisen und Bewegungsdrang hilfreich sein. Bei der BN sind Antidepressiva das medikamentöse Behandlungsverfahren der ersten Wahl. Langzeiteffekte sind allerdings noch unbekannt.

Abstract

Psychotherapy is the treatment of choice for both anorexia nervosa and for bulimia nervosa. However, many patients are also treated by pharmaceutical drugs. For the clinician it is difficult to choose pharmacotherapy, because the drugs may not be licensed, because of pharmacodynamic problems due to underweight or purging behaviour, or because of comorbidity. The present review summarises the current knowledge on pharmacotherapy for anorexia nervosa and bulimia nervosa considering the available guidelines. In general, the knowledge based on studies is insufficient for anorexia nervosa. Up to now, there is no proof of efficacy for any antidepressant or atypical antipsychotic with respect to weight gain; atypical antipsychotics may be helpful for ruminating or excessive motor hyperactivity. For bulimia nervosa antidepressants are the pharmacotherapy of first choice. Long-term effects, however, are still unknown.

Schlüsselwörter

Essstörungen - Anorexia nervosa - Bulimia nervosa - Pharmakotherapie

Key words

eating disorders - anorexia nervosa - bulimia nervosa - pharmacotherapy
 

  • Literatur

  • 1 WHO. Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V (F). Klinisch-diagnostische Leitlinien. 7. Aufl. Bern: Huber; 2009
    Search in Google Scholar
  • 2 Practice guideline for the treatment of patients with eating disorders. 3rd. edition American Psychiatric Association (APA); 2006
    Search in Google Scholar
  • 3 S3-Leitlinie „Diagnostik und Therapie der Essstörungen“. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF); 2010
    PubMedSearch in Google Scholar
  • 4 Currin L, Schmidt U, Treasure J et al. Time trends in eating disorder incidence. Br J Psychiatry 2005; 186: 132-135
    Search in Google Scholar
  • 5 Fichter MM, Quadflieg N, Hedlund S. Twelve-year course and outcome predictors of anorexia nervosa. Int J Eat Disord 2006; 39: 87-100
    CrossrefPubMedSearch in Google Scholar
  • 6 Fichter MM, Quadflieg N, Hedlund S. Long-term course of binge eating disorder and bulimia nervosa: relevance for nosology and diagnostic criteria. Int J Eat Disord 2008; 41: 577-586
    CrossrefPubMedSearch in Google Scholar
  • 7 Voderholzer U, Hohagen F. Essstörungen (ICD-10 F5). In: Therapie psychischer Erkrankungen: State of the Art 2010/2011. 6. Aufl. Urban & Fischer Verlag/Elsevier GmbH; 2010: 289-302
    Search in Google Scholar
  • 8 Kaye W. Neurobiology of anorexia and bulimia nervosa. Physiol Behav 2008; 94: 121-135
    CrossrefPubMedSearch in Google Scholar
  • 9 Flament MF, Bissada H, Spettigue W. Evidence-based pharmacotherapy of eating disorders. Int J Neuropsychopharmacol 2011; 18: 1-19
    CrossrefPubMedSearch in Google Scholar
  • 10 Hay PJ, Claudino AM. Clinical psychopharmacology of eating disorders: a research update. Int J Neuropsychopharmacol 2011; 25: 1-14
    PubMedSearch in Google Scholar
  • 11 Eating disorders: full guideline (CG9). National Institute for Health and Clinical Excellence (NICE). 2004;
    PubMedSearch in Google Scholar
  • 12 Fassino S, Piero A, Tomba E et al. Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry 2009; 9: 67-67
    CrossrefPubMedSearch in Google Scholar
  • 13 Biederman J, Herzog DB, Rivinus TM et al. Amitriptyline in the treatment of anorexia nervosa: a double-blind, plazebo-controlled study. J Clin Psychopharmacol 1985; 5: 10-16
    PubMedSearch in Google Scholar
  • 14 Halmi KA, Eckert E, LaDu TJ et al. Anorexia nervosa. Treatment efficacy of cyproheptadine and amitriptyline. Arch Gen Psychiatry 1986; 43: 177-181
    PubMedSearch in Google Scholar
  • 15 Attia E, Haiman C, Walsh BT et al. Does fluoxetine augment the inpatient treatment of anorexia nervosa?. Am J Psychiatry 1998; 155: 548-551
    PubMedSearch in Google Scholar
  • 16 Fassino S, Leombruni P, Daga G et al. Efficacy of citalopram in anorexia nervosa: a pilot study. Eur Neuropsychopharmacol 2002; 12: 453-459
    PubMedSearch in Google Scholar
  • 17 Walsh BT, Kaplan AS, Attia E et al. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. JAMA 2006; 295: 2605-2612
    Search in Google Scholar
  • 18 Santonastaso P, Friederici S, Favaro A. Sertraline in the treatment of restricting anorexia nervosa: an open controlled trial. J Child Adolesc Psychopharmacol 2001; 11: 143-150
    CrossrefPubMedSearch in Google Scholar
  • 19 Strober M, Freeman R, DeAntonio M et al. Does adjunctive fluoxetine influence the post-hospital course of restrictor-type anorexia nervosa?. A 24-month prospective, longitudinal followup and comparison with historical controls. Psychopharmacol Bull 1997; 33: 425-431
    PubMedSearch in Google Scholar
  • 20 Ruggiero GM, Mauri MC, Omboni AC et al. Nutritional management of anorexic patients with and without fluoxetine: 1-year follow-up. Prog Neuropsychopharmacol Biol Psychiatry 2003; 27: 425-430
    CrossrefPubMedSearch in Google Scholar
  • 21 Kaye WH, Nagata T, Weltzin TE et al. Double-blind plazebo-controlled administration of fluoxetine in restricting- and restricting-purging-type anorexia nervosa. Biol Psychiatry 2001; 49: 644-652
    Search in Google Scholar
  • 22 Ruggiero GM, Laini V, Mauri MC et al. A single blind comparison of amisulpride, fluoxetine and clomipramine in the treatment of restricting anorectics. Prog Neuropsychopharmacol Biol Psychiatry 2001; 25: 1049-1059
    CrossrefPubMedSearch in Google Scholar
  • 23 Lacey JH, Crisp AH. Hunger, food intake and weight: the impact of clomipramine on a refeeding anorexia nervosa population. Postgrad Med J 1980; 56 (Suppl. 01) 79-85
    PubMedSearch in Google Scholar
  • 24 Jaafar NR, Daud TI, Rahman FN et al. Mirtazapine for anorexia nervosa with depression. Aust N Z J Psychiatry 2007; 41: 768-769
    CrossrefPubMedSearch in Google Scholar
  • 25 Safer DL, Darcy AM, Lock J. Use of mirtazapine in an adult with refractory anorexia nervosa and comorbid depression: a case report. Int J Eat Disord 2011; 44: 178-181
    PubMedSearch in Google Scholar
  • 26 Hrdlicka M, Beranova I, Zamecnikova R et al. Mirtazapine in the treatment of adolescent anorexia nervosa. Case-control study. Eur Child Adolesc Psychiatry 2008; 17: 187-189
    PubMedSearch in Google Scholar
  • 27 Claudino AM, Hay P, Lima MS et al. Antidepressants for anorexia nervosa. Cochrane Database Syst Rev 2006; CD004365
    PubMedSearch in Google Scholar
  • 28 Godart NT, Perdereau F, Rein Z et al. Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. J Affect Disord 2007; 97: 37-49
    PubMedSearch in Google Scholar
  • 29 Mischoulon D, Eddy KT, Keshaviah A et al. Depression and eating disorders: Treatment and course. J Affect Disord 2010;
    PubMedSearch in Google Scholar
  • 30 Ricca V, Mannucci E, Paionni A et al. Venlafaxine versus fluoxetine in the treatment of atypical anorectic outpatients: a preliminary study. Eat Weight Disord 1999; 4: 10-14
    PubMedSearch in Google Scholar
  • 31 Meehan KG, Loeb KL, Roberto CA et al. Mood change during weight restoration in patients with anorexia nervosa. Int J Eat Disord 2006; 39: 587-589
    CrossrefPubMedSearch in Google Scholar
  • 32 Barbarich NC, McConaha CW, Gaskill J et al. An open trial of olanzapine in anorexia nervosa. J Clin Psychiatry 2004; 65: 1480-1482
    CrossrefPubMedSearch in Google Scholar
  • 33 Boachie A, Goldfield GS, Spettigue W. Olanzapine use as an adjunctive treatment for hospitalized children with anorexia nervosa: case reports. Int J Eat Disord 2003; 33: 98-103
    CrossrefPubMedSearch in Google Scholar
  • 34 Powers PS, Santana CA, Bannon YS. Olanzapine in the treatment of anorexia nervosa: an open label trial. Int J Eat Disord 2002; 32: 146-154
    CrossrefPubMedSearch in Google Scholar
  • 35 Bissada H, Tasca GA, Barber AM et al. Olanzapine in the treatment of low body weight and obsessive thinking in women with anorexia nervosa: a randomized, double-blind, plazebo-controlled trial. Am J Psychiatry 2008; 165: 1281-1288
    CrossrefPubMedSearch in Google Scholar
  • 36 Brambilla F, Monteleone P, Maj M. Olanzapine-induced weight gain in anorexia nervosa: involvement of leptin and ghrelin secretion?. Psychoneuroendocrinology 2007; 32: 402-406
    CrossrefPubMedSearch in Google Scholar
  • 37 Mondraty N, Birmingham CL, Touyz S et al. Randomized controlled trial of olanzapine in the treatment of cognitions in anorexia nervosa. Australas Psychiatry 2005; 13: 72-75
    PubMedSearch in Google Scholar
  • 38 Malina A, Gaskill J, McConaha C et al. Olanzapine treatment of anorexia nervosa: a retrospective study. Int J Eat Disord 2003; 33: 234-237
    CrossrefPubMedSearch in Google Scholar
  • 39 Weizman A, Tyano S, Wijsenbeek H et al. Behavior therapy, pimozide treatment and prolactin secretion in anorexia nervosa. Psychother Psychosom 1985; 43: 136-140
    CrossrefPubMedSearch in Google Scholar
  • 40 Vandereycken W, Pierloot R. Pimozide combined with behavior therapy in the short-term treatment of anorexia nervosa. A double-blind plazebo-controlled cross-over study. Acta Psychiatr Scand 1982; 66: 445-450
    CrossrefPubMedSearch in Google Scholar
  • 41 Vandereycken W. Neuroleptics in the short-term treatment of anorexia nervosa. A double-blind plazebo-controlled study with sulpiride. Br J Psychiatry 1984; 144: 288-292
    CrossrefPubMedSearch in Google Scholar
  • 42 Cassano GB, Miniati M, Pini S et al. Six-month open trial of haloperidol as an adjunctive treatment for anorexia nervosa: a preliminary report. Int J Eat Disord 2003; 33: 172-177
    CrossrefPubMedSearch in Google Scholar
  • 43 Bosanac P, Kurlender S, Norman T et al. An open-label study of quetiapine in anorexia nervosa. Hum Psychopharmacol 2007; 22: 223-230
    CrossrefPubMedSearch in Google Scholar
  • 44 Powers PS, Bannon Y, Eubanks R et al. Quetiapine in anorexia nervosa patients: an open label outpatient pilot study. Int J Eat Disord 2007; 40: 21-26
    CrossrefPubMedSearch in Google Scholar
  • 45 Court A, Mulder C, Kerr M et al. Investigating the effectiveness, safety and tolerability of quetiapine in the treatment of anorexia nervosa in young people: a pilot study. J Psychiatr Res 2010; 44: 1027-1034
    CrossrefPubMedSearch in Google Scholar
  • 46 Trunko ME, Schwartz TA, Duvvuri V et al. Aripiprazole in anorexia nervosa and low-weight bulimia nervosa: case reports. Int J Eat Disord 2011; 44: 269-275
    CrossrefPubMedSearch in Google Scholar
  • 47 Gross H, Ebert MH, Faden VB et al. A double-blind trial of delta 9-tetrahydrocannabinol in primary anorexia nervosa. J Clin Psychopharmacol 1983; 3: 165-171
    PubMedSearch in Google Scholar
  • 48 Gross HA, Ebert MH, Faden VB et al. A double-blind controlled trial of lithium carbonate primary anorexia nervosa. J Clin Psychopharmacol 1981; 1: 376-381
    CrossrefPubMedSearch in Google Scholar
  • 49 Birmingham CL, Goldner EM, Bakan R. Controlled trial of zinc supplementation in anorexia nervosa. Int J Eat Disord 1994; 15: 251-255
    PubMedSearch in Google Scholar
  • 50 Pope Jr HG, Hudson JI, Jonas JM et al. Bulimia treated with imipramine: a plazebo-controlled, double-blind study. Am J Psychiatry 1983; 140: 554-558
    PubMedSearch in Google Scholar
  • 51 Barlow J, Blouin J, Blouin A et al. Treatment of bulimia with desipramine: a double-blind crossover study. Can J Psychiatry 1988; 33: 129-133
    PubMedSearch in Google Scholar
  • 52 Sabine EJ, Yonace A, Farrington AJ et al. Bulimia nervosa: a plazebo controlled double-blind therapeutic trial of mianserin. Br J Clin Pharmacol 1983; 15 (Suppl. 02) 195S-202S
    CrossrefPubMedSearch in Google Scholar
  • 53 Goldstein DJ, Wilson MG, Thompson VL et al. Long-term fluoxetine treatment of bulimia nervosa. Fluoxetine Bulimia Nervosa Research Group. Br J Psychiatry 1995; 166: 660-666
    PubMedSearch in Google Scholar
  • 54 Fluoxetine Bulimia Nervosa Collaborative Study Group. Fluoxetine in the treatment of bulimia nervosa. A multicenter, plazebo-controlled, double-blind trial. Arch Gen Psychiatry 1992; 49: 139-147
    CrossrefPubMedSearch in Google Scholar
  • 55 Fichter MM, Leibl K, Rief W et al. Fluoxetine versus plazebo: a double-blind study with bulimic inpatients undergoing intensive psychotherapy. Pharmacopsychiatry 1991; 24: 1-7
    Thieme ConnectPubMedSearch in Google Scholar
  • 56 Fichter MM, Leibl C, Kruger R et al. Effects of fluvoxamine on depression, anxiety, and other areas of general psychopathology in bulimia nervosa. Pharmacopsychiatry 1997; 30: 85-92
    Thieme ConnectPubMedSearch in Google Scholar
  • 57 Milano W, Petrella C, Sabatino C et al. Treatment of bulimia nervosa with sertraline: a randomized controlled trial. Adv Ther 2004; 21: 232-237
    CrossrefPubMedSearch in Google Scholar
  • 58 Capasso A, Petrella C, Milano W. Pharmacological profile of SSRIs and SNRIs in the treatment of eating disorders. Curr Clin Pharmacol 2009; 4: 78-83
    CrossrefPubMedSearch in Google Scholar
  • 59 Pope Jr HG , Keck Jr PE , McElroy SL et al. A plazebo-controlled study of trazodone in bulimia nervosa. J Clin Psychopharmacol 1989; 9: 254-259
    PubMedSearch in Google Scholar
  • 60 Bacaltchuk J, Hay P. Antidepressants versus plazebo for people with bulimia nervosa. Cochrane Database Syst Rev 2003; CD003391
    PubMedSearch in Google Scholar
  • 61 Carruba MO, Cuzzolaro M, Riva L et al. Efficacy and tolerability of moclobemide in bulimia nervosa: a plazebo-controlled trial. Int Clin Psychopharmacol 2001; 16: 27-32
    CrossrefPubMedSearch in Google Scholar
  • 62 Horne RL, Ferguson JM, Pope Jr HG et al. Treatment of bulimia with bupropion: a multicenter controlled trial. J Clin Psychiatry 1988; 49: 262-266
    PubMedSearch in Google Scholar
  • 63 Romano SJ, Halmi KA, Sarkar NP et al. A plazebo-controlled study of fluoxetine in continued treatment of bulimia nervosa after successful acute fluoxetine treatment. Am J Psychiatry 2002; 159: 96-102
    CrossrefPubMedSearch in Google Scholar
  • 64 Schmidt U, Cooper PJ, Essers H et al. Fluvoxamine and graded psychotherapy in the treatment of bulimia nervosa: a randomized, double-blind, plazebo-controlled, multicenter study of short-term and long-term pharmacotherapy combined with a stepped care approach to psychotherapy. J Clin Psychopharmacol 2004; 24: 549-552
    PubMedSearch in Google Scholar
  • 65 Sysko R, Sha N, Wang Y et al. Early response to antidepressant treatment in bulimia nervosa. Psychol Med 2010; 40: 999-1005
    CrossrefPubMedSearch in Google Scholar
  • 66 Goldstein DJ, Wilson MG, Ascroft RC et al. Effectiveness of fluoxetine therapy in bulimia nervosa regardless of comorbid depression. Int J Eat Disord 1999; 25: 19-27
    CrossrefPubMedSearch in Google Scholar
  • 67 Agras WS, Rossiter EM, Arnow B et al. Pharmacologic and cognitive-behavioral treatment for bulimia nervosa: a controlled comparison. Am J Psychiatry 1992; 149: 82-87
    PubMedSearch in Google Scholar
  • 68 Goldbloom DS, Olmsted M, Davis R et al. A randomized controlled trial of fluoxetine and cognitive behavioral therapy for bulimia nervosa: short-term outcome. Behav Res Ther 1997; 35: 803-811
    CrossrefPubMedSearch in Google Scholar
  • 69 Bacaltchuk J, Hay P, Trefiglio R. Antidepressants versus psychological treatments and their combination for bulimia nervosa. Cochrane Database Syst Rev 2001; CD003385
    PubMedSearch in Google Scholar
  • 70 Nickel C, Tritt K, Muehlbacher M et al. Topiramate treatment in bulimia nervosa patients: a randomized, double-blind, plazebo-controlled trial. Int J Eat Disord 2005; 38: 295-300
    CrossrefPubMedSearch in Google Scholar
  • 71 Hedges DW, Reimherr FW, Hoopes SP et al. Treatment of bulimia nervosa with topiramate in a randomized, double-blind, plazebo-controlled trial, part 2: improvement in psychiatric measures. J Clin Psychiatry 2003; 64: 1449-1454
    CrossrefPubMedSearch in Google Scholar
  • 72 Hoopes SP, Reimherr FW, Hedges DW et al. Treatment of bulimia nervosa with topiramate in a randomized, double-blind, plazebo-controlled trial, part 1: improvement in binge and purge measures. J Clin Psychiatry 2003; 64: 1335-1341
    CrossrefPubMedSearch in Google Scholar
  • 73 Faris PL, Kim SW, Meller WH et al. Effect of decreasing afferent vagal activity with ondansetron on symptoms of bulimia nervosa: a randomised, double-blind trial. Lancet 2000; 355: 792-797
    CrossrefPubMedSearch in Google Scholar
  • 74 Hsu LK, Clement L, Santhouse R et al. Treatment of bulimia nervosa with lithium carbonate. A controlled study. J Nerv Ment Dis 1991; 179: 351-355
    CrossrefPubMedSearch in Google Scholar