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Review
. 2024 Feb 22;16(5):594.
doi: 10.3390/nu16050594.

Pharmacological Studies in Eating Disorders: A Historical Review

Yael D Lewis  1   2 , Lukas Bergner  3 , Holger Steinberg  3 , Jessica Bentley  4 , Hubertus Himmerich  4   5
Affiliations
Review

Pharmacological Studies in Eating Disorders: A Historical Review

Yael D Lewis et al. Nutrients. .

Abstract

Eating disorders (EDs) are serious mental health conditions characterised by impaired eating behaviours and nutrition as well as disturbed body image, entailing considerable mortality and morbidity. Psychopharmacological medication is an important component in the treatment of EDs. In this review, we performed a historic analysis of pharmacotherapeutic research in EDs based on the scientific studies included in the recently published World Federation of Societies for Biological Psychiatry (WFSBP) guidelines for ED treatment. This analysis focuses on early approaches and trends in the methods of clinical pharmacological research in EDs, for example, the sample sizes of randomised controlled trials (RCTs). We found the development of psychopharmacological treatments for EDs followed advancements in psychiatric pharmacotherapy. However, the application of RCTs to the study of pharmacotherapy for EDs may be an impediment as limited participant numbers and inadequate research funding impede generalisability and statistical power. Moreover, current medication usage often deviates from guideline recommendations. In conclusion, the RCT model may not effectively capture the complexities of ED treatment, and funding limitations hinder research activity. Novel genetically/biologically based treatments are warranted. A more comprehensive understanding of EDs and individualised approaches should guide research and drug development for improved treatment outcomes.

Keywords: eating disorders; history; medication; psychopharmacology.

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Conflict of interest statement

Hubertus Himmerich has received research funding from the NIHR for a feasibility study testing olanzapine in AN and from COMPASS Pathways for a proof-of-concept study on psilocybin in AN.

Figures

Figure 1
Figure 1
Timeline of pharmacological studies in anorexia nervosa by medication group. (A). Cumulative number of patients who participated in studies, colour coded by medication group. (B). Number of new participants per year in studies, colour coded by medication group. SSRIs: selective serotonin reuptake inhibitors.
Figure 2
Figure 2
Effects found in placebo-controlled trials by medication group and number of participants (N). Each dot represents a single study. (A). Effect (weight gain) found in anorexia nervosa placebo-controlled trials. (B). Effects (binge and/or purge reduction) found in bulimia nervosa placebo-controlled trials. (C). Effects (binge reduction and weight loss) found in binge eating disorder placebo- controlled trials.
Figure 3
Figure 3
Timeline of pharmacological studies in bulimia nervosa by medication group. (A). Cumulative number of patients who participated in studies, colour coded by medication group. (B). Number of new participants per year in studies colour coded by medication group. ADHD: attention deficit hyperactivity disorder, MAO-I: monoamine-oxidase inhibitors, SSRIs: selective serotonin reuptake inhibitors.
Figure 4
Figure 4
Timeline of pharmacological studies in binge eating disorder by medication group. (A). Cumulative number of patients who participated in studies, colour coded by medication group. (B). Number of new participants per year in studies, colour coded by medication group. GABA: Gamma-Aminobutyric Acid, SSRIs: selective serotonin reuptake inhibitors, ADHD: attention deficit hyperactivity disorder.
Figure 5
Figure 5
Pharmacological studies according to funding and outcome. Funding was classified as pharma funding if any pharmaceutical involvement was mentioned in the article, whereas specific mention of an academic grant was classified as academic funding. Outcomes include weight gain for anorexia nervosa, binge and purge reduction for bulimia nervosa and binge reduction and weight loss for binge eating disorder or no effects shown.
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