In a double-blind, placebo-controlled trial, cyproheptadine, 4 to 8 mg tid, was associated with weight gain and reduced depressive symptoms in anorexia nervosa patients.18 Unlike tricyclic antidepressants, cyproheptadine does not reduce blood pressure or increase heart rate, which makes it attractive for emaciated anorectic patients. Dosages up to 28 mg/d can be used safely.
The SSRI fluoxetine may help prevent weight loss relapse in anorexia nervosa and reduce obsessive-compulsive behaviors.19 In open studies of low-weight anorectics, however, fluoxetine had little impact on weight or other clinically meaningful variables.20 Thus, this agent is recommended for preventing weight-loss relapse only in patients who are within 10% to 15% of ideal body weight.
Outpatient care
Case report continued: Ongoing therapy
During hospitalization, Ms. J participated in all therapeutic modalities but had difficulty eating enough to gain weight. She reached her target weight of 127 lbs in about 7 weeks but gained no sense of purpose in life.
She is starting an intensive outpatient program using CBT to maintain her weight and further address the core psychopathology of her illness. Her maintenance therapy includes attending Alcoholics Anonymous meetings, ongoing fluoxetine (20 mg/d) to prevent weight-loss relapse, and CBT for obsessions and compulsions not related to her eating disorder.
Related resources
- Halmi KA. Eating disorders: Anorexia, bulimia nervosa and obesity. In: Hales RE, Yudofsky SC (eds). Textbook of clinical psychiatry, 4th ed. Washington, DC: American Psychiatric Publishing, 2003:1001-21.
- Academy of Eating Disorders. www.aedweb.org
- Anorexia Nervosa & Associated Disorders (ANAD). www.anad.org
Drug brand names
- Chlorpromazine • Thorazine
- Cyproheptadine • Periactin
- Fluoxetine • Prozac
- Olanzapine • Zyprexa
Disclosure
The author reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.