Letters to the Editor
Psychopharmatherapeutic Options
In many mental disorders, insufficient consideration of gender-specific aspects can result in inadequate diagnosis and treatment. The authors therefore deserve thanks for their review article about eating disorders in men (1).
In treating eating disorders, psychotherapy is obviously the priority. In spite of this, however, evidence based psychopharmacologic therapeutic options exist in the setting of eating disorders, although gender-specific aspects have been insufficiently studied here, too.
The evidence for effectiveness, safety, and tolerability of pharmacotherapy for anorexia nervosa is rather poor, in spite of numerous studies and investigated substances. The S3 guideline on the diagnosis and treatment of eating disorders is currently being revised; it recommends with a weak evidence level (2a) merely olanzapine (off label) “[. . .] if thinking is substantially restricted to weight anxiety and eating [. . .]” (2).
For bulimia nervosa the evidence is much better and quite robust, especially for the group of selective serotonin reuptake inhibitors (SSRIs) as regards a positive effect on eating binges and dysfunctional cognition concerning body and weight. Furthermore, antibulimic effects exist independently of the presence of a comorbid depressive disorder (2). However, in Germany, fluoxetine is the only SSRI that is licensed for the treatment of bulimia nervosa (only in combination with psychotherapy). Additionally, for fluoxetine used in an antibulimic indication, the are signs of a positive dose-response relationship, and higher dosages (up to 60 mg/day) and a longer period of use (at least four weeks) are required than for treatment of depression (3).
The evidence for pharmacotherapy in binge eating disorder is limited, but there is evidence for efficacy of lisdexamfetamine and several antidepressants as well as anticonvulsant drugs, with long term data still outstanding (2).
DOI: 10.3238/arztebl.m2024.0096
Prof. Dr. Maximilian Gahr, MA
Krankenhaus für Psychiatrie, Psychotherapie und Psychosomatische
Medizin, Schloß Werneck, Werneck
maximilian.gahr@kh-schloss-werneck.de
| 1. | Halbeisen G, Laskowski N, Brandt G, Waschescio U, Paslakis G: Eating disorders in men—an underestimated problem, an unseen need. Dtsch Arztebl Int 2024; 121: 86–91 VOLLTEXT |
| 2. | Herpertz S, Fichter M, Herpertz-Dahlmann B, et al. (eds.): S3-Leitlinie Diagnostik und Behandlung der Essstörungen (2nd edition). Berlin: Springer 2018 CrossRef |
| 3. | Walsh BT, Agras WS, Devlin MJ, et al.: Fluoxetine for bulimia nervosa following poor response to psychotherapy. Am J Psychiatry 2000; 157: 1332–4 CrossRef MEDLINE |
