There are no medications and few therapies available to effectively treat patients suffering from anorexia nervosa, according to a new report by researchers at the RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.

However, the researchers did find evidence of medications and behavioral and psychological therapies that show promise in treating those suffering from bulimia nervosa and binge eating disorder.

In a systematic evidence review funded by the Agency for Healthcare Research and Quality, the Office of Research on Women’s Health at the National Institutes of Health and the Health Resources and Services Administration, researchers examined 181 research studies on treatment and outcomes for anorexia nervosa, bulimia nervosa and binge eating disorder.

“Patients suffering from anorexia nervosa have an increased risk of mortality from factors related to starvation and from suicide,” said Dr. Nancy Berkman, a senior research analyst at RTI International and co-author of the report. “Over the long term, 10 years or more, only half of the patients diagnosed with anorexia nervosa or bulimia nervosa will be considered recovered. Approximately 10 percent will still meet the diagnostic criteria for these disorders, while others will continue to exhibit symptoms but to a lesser degree. Finding treatments that help these patients is critical.”

Although the report did not identify any behavioral interventions or medical treatments that were effective in treating chronic anorexia nervosa patients, specific forms of family therapy were found to be beneficial for younger nonchronic patients. Cognitive behavioral therapy also showed some promise in reducing relapse risk after anorexia nervosa patients regained a healthy weight.

Dr. Cynthia Bulik, co-author of the report and director of the UNC Eating Disorders Program, emphasized that “finding effective treatments for anorexia nervosa is critically important in order to reduce the burden and duration of suffering for both patients and their family members.”

The evidence on bulimia treatments was more encouraging.

Researchers found that cognitive behavioral therapy was an effective treatment for bulimia nervosa. In addition, 60 milligrams per day of fluoxetine, commonly known as Prozac, reduced the core symptoms of bulimia nervosa in the short term. However, the report suggests more research is needed to determine the optimal length of treatment and the best strategy for maintaining its benefits.

According to researchers, several medications showed promise in reducing symptoms of binge eating disorder in short-term trials, including selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants; tricyclic antidepressants; an anticonvulsant; and an appetite suppressant. Cognitive behavioral therapy and various forms of self-help also were effective at reducing binge eating, but less effective at controlling weight. Binge eating disorder is characterized by eating large amounts of food while feeling a loss of control over eating.

Results of the evidence review suggest more research is needed on treatment approaches for all three disorders with particular emphasis on factors that may influence the results of treatment, the possible harms of treatment and whether optimal approaches differ depending on a patient’s sex, gender, age, race, ethnicity and cultural group. The researchers also recommend developing a consensus about terminology for remission, recovery and relapse.

The evidence review was conducted by AHRQ’s RTI-UNC Evidence-based Practice Center - a collaboration between RTI and the five health professions schools and the Cecil G. Sheps Center for Health Services Research at UNC. Researchers reviewed studies conducted from 1980 through 2005 of males and females 10 years of age and older conducted in various countries.

http://www.ahrq.gov/clinic/epcix.htm