A drug, perhaps?
The atypical antipsychotic olanzapine (brand name Zyprexa) has long been discussed in the eating disorders field as a possible medication to help treat anorexia. There certainly are psychotic-like features to an eating disorder: distorted body image, intense fear of food, etc. Add to the mix that one of the major side effects of Zyprexa is weight gain, and you have what sounds like a perfect tool to help treat anorexia.
But it had never been formally evaluated. It's commonly used off-label (I've used it, but it was tentatively linked to my seizures so I stopped taking it), but no one knew first hand whether the drug was effective. Anecdotes are wonderful, but they're not research.
Enter the randomized, double-blind, placebo-controlled trial, pretty much the gold standard in research. Patients are divided into two groups, one that receives the treatment (olanzapine, here), and one that receives the placebo. It's done so randomly to make sure that no strange quirk of fate affects which patients receive which treatments. Double blind means neither the doctor nor the patient know if they are getting the pill or the placebo. This kind of trial does its best to ensure that any sort of effect you see is from the drug itself and NOT because the patient thinks it might be working or the doctor thinks it might be working.
What the researchers found, in an article from the American Journal of Psychiatry is that "olanzapine may be safely used in achieving more rapid weight gain and improvement in obsessive symptoms among women with anorexia nervosa. Replication, in the form of a large multicenter trial, is recommended."
Lower weight at discharge is associated with higher rates of relapse, so a medication that enables sufferers to get to that weight more quickly (essential in today's get-em-in, get-em-out medical system) may decrease a lot of suffering in the long run. And to decrease obsessionality at the same time means it may be more bearable, too.
It's not a magic pill. There are side effects- I wouldn't put it in the water at an ED clinic. There's also the matter of convincing patients to take the pill, and what to do about refusal. And you still need to gain weight and re-learn how to eat. You still need to learn how to deal with anxiety and moods and madness so you don't have to self-medicate with anorexia any more. But if you can get there more quickly and more easily, I think it has a lot of promise.
11 comments:
A friend who was prescribed it while in treatment for her ED was so delighted with the results that she resolved to call her first child either Eli or Lilly depending on gender!
On the other hand, as you have pointed out, there is no magic pill. ALL medications (and therapies) come with associated side effects, and withdrawing from them can be difficult (tip here, don't do as my daughter did and just stop taking them while simultaneously trying to sort out your career and housing and with no therapeutic and very little medical back up - it'll worry your mother to distraction.
Was there anything written about what happened after patients stopped taking the pill? Surely the self-esteem issues remained dormant and re-surfaced? Or did the medication actually give patients the mental resources to sort out the majority of their emotional problems regarding refeeding while they were on the drug? This research is certainly encouraging, but as you say there is no magic solution...
TAx
TA,
To me, it's hard to do the necessary work in therapy unless you're at a healthy weight. The eating disorder masks feelings of anxiety and such, so it's only when the bandaid of starvation is ripped off that you can start to heal. In my mind, the sooner you get to a healthy weight, the sooner you can start work on the rest of recovery.
Marcella,
That name thing is hilarious.
The only thing I wonder about with this study is this--the patients under consideration here were in day treatment, presumably simultaneously being refed & therefore regaining the nutrients & weight needed for health. In that scenario, anything that can help w/ weight gain & obsession makes perfect sense, since the patients are already getting the nutrition they need to repair their bodies. But what about in an outpatient setting? What if the patient is simply put on a drug that causes weight gain, & yes, decreases obsession, which is important, but the weight gain comes from a slowed metabolism (or however the drug causes it) and not from the combo of the drug w/ good nutrition? Will it still be as effective if the patient is still starving their body, but their body is simply no longer responding to that starvation in the same way? Will it help people regain HEALTH & not just weight?
I suppose that's left to be determined...but that's what I'm curious about!
Try convincing someone with anorexia to take a pill that causes weight gain......good luck. Wish it was that easy, sadly it so isn't
You're right- it isn't that easy. The purpose of the med isn't necessarily to *cause* weight gain. A lot of it is that the med helps patients gain faster, but Zyprexa alone won't cause you to gain weight. But it's also common protocol in many inpatient programs to prescribe these meds and there's a fairly high level of compliance among patients. It's a tool, but one that could be important.
Seroquel is weight neutral (well a little more than Olanzipine) -- I was on this for about 6 months while in the weight restoration phase of recovery -- it really did help with urges to restrict, anxiety and broken record thoughts. I was on a very low dose so I don't think it made all that much difference in terms of weight gain.
I guess if Olzapine isn't an option or is refused there are other antipsychotics.
A:)
There's a study on Seroquel in AN at UCSD now. It'll be interesting to see the results.
A,
I take half of the lowest dose of Seroquel before bed to help me sleep. I get really wound up and anxious at night and so can't sleep (I wouldn't fall asleep until 6 or 7 am without it). That it makes you drowsy no doubt helps!
Jane,
I will keep my eye on that. I would love to see studies of if these drugs work on different pathways in those with AN as opposited to schizophrenia, etc.
Oh, and I will have the MP stuff to you later today!
My daughter took zyprexa for 3 days when she was very ill. We had to take her off it because of side effects (dyskinesia), and she *cried.* She said taking the drug made the voice in her head quiet down. That made me cry, of course. I don't know how it works but it seems to me the weight gain side effect is not the main reason to prescribe it--it's the fact that it can shut that voice down, at least somewhat, and so reduce suffering.
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