Wasting Away: Prozac loses promise as anorexia nervosa fighter

Psychiatrists often prescribe fluoxetine, or Prozac, to people suffering from the difficult-to-treat, potentially fatal condition known as anorexia nervosa. Yet the medication appears to provide no benefit in treating the eating disorder, a new investigation reports.

Symptoms of anorexia nervosa consist of a refusal to eat enough to maintain adequate body weight, intense fears of gaining weight, and disturbed thinking about food, weight, and body image. The predominantly female ailment often includes a denial of the seriousness of weight loss and refusal to participate in treatment.

In some cases, binge eating and purging occur periodically.

National surveys suggest that about 1 in 1,000 adults develops anorexia nervosa. A higher prevalence, 1 in 100, shows up among teenage girls and young women. The illness frequently occurs with mental ailments, such as depression and obsessive-compulsive disorder, that respond to Prozac treatment. Clinicians had anticipated similar success in treating anorexia with the drug.

The new study, directed by psychiatrist B. Timothy Walsh of Columbia University, may dash that hope. “It makes more sense to focus on nutritional restoration and maintenance and the provision of good psychological treatment,” Walsh says.

He and his colleagues present their findings in the June 14 Journal of the American Medical Association.

The researchers studied 93 women, ages 16 to 45, treated for anorexia nervosa between January 2000 and May 2005. Nearly half of them had binged and purged. Participants had regained weight and maintained it at a healthy level for 2 weeks in hospital programs in New York or Toronto.

Walsh’s team then randomly assigned 49 of the women to take physician-monitored doses of Prozac for a year. The rest received placebo pills. All patients attended weekly sessions of cognitive behavioral therapy that focused on identifying and altering anorexia-related attitudes and habits.

Prozac displayed no advantage over placebos, the researchers say. In both groups, 57 percent of participants failed to complete treatment. For those who finished 1 year of treatment, 73 percent of the placebo group and 71 percent of the Prozac group maintained healthy weights and experienced no return of symptoms.

Taking dropouts into account, 51 percent of the placebo group and 49 percent of the Prozac group avoided relapses.

Psychiatrist Scott J. Crow of the University of Minnesota in Minneapolis counters the new results “important but disappointing.” Research on the biology and treatment of anorexia nervosa needs to intensify, he asserts.

It’s too early to close the door on Prozac treatment for anorexia nervosa, counters psychiatrist Walter H. Kaye of the University of Pittsburgh Medical Center. In a 2001 study, he and his coworkers reported substantially better 1-year results for 16 anorexia nervosa patients randomly assigned to Prozac treatment, compared with 19 patients given placebos.

In Kaye’s study, all participants received psychotherapy. A lack of prior bingeing and purging in the group might also have enhanced Prozac responses, he suggests.

“We clearly need more studies and innovative treatments,” Kaye says.

Kaye is part of a team that’s recruiting for a genetic study 400 families with two or more members diagnosed with anorexia nervosa.