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cont. from
Anorexia nervosa in some ways resembles other major psychiatric disorders
such as depression and
obsessive-compulsive disorder (OCD), because some of the
symptoms of these disorders, for example obsessive behavior, lack of enjoyment
from life, and severely distorted perception of reality (in this case, of the
body), are exhibited by people with anorexia. This has led to the use of
antidepressants for anorexia, particularly
selective serotonin reuptake
inhibitors (SSRIs), because these drugs are first-line treatments for OCD and
depression. Medications, however, do not work alone and must be used in
conjunction with a multidisciplinary approach that includes nutritional
interventions and psychotherapy.
SSRIs for Anorexia (Serotonin Reuptake Inhibitors)
Studies suggest that fluoxetine may increase weight and improve mood over
several months in people with anorexia nervosa and depression. Similarly
positive results were obtained in a preliminary study of anorexics whose body
weight had already been partly restored.
Tricyclics for Anorexia (Tricyclic Antidepressants)
This class of antidepressants, including imipramine and desipramine, tend to
be more effective for bulimia than anorexia.
One study suggests that clomipramine has the potential to stimulate weight
gain and improve symptoms of anorexia, but more research is needed on the value
of this drug in treating this particular eating disorder.
Antihistamines for Anorexia
In a study using high doses of cyproheptadine hydrochloride, which is thought
to stimulate appetite, the number of days necessary to achieve appropriate
weight gain were decreased and depression was relieved in those with restricting
type anorexia.
Hormones
Estrogen together with progesterone may be used to restore normal menstrual
cycles. This, however, does not generally have any effect on weight.
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Anorexics with low body weight, low BMI, and low serum albumin (the main
protein in blood) levels are at increased risk for vitamin and mineral
deficiency. Vitamin abnormalities may contribute to cognitive difficulties such
as poor judgment or memory loss and other psychiatric conditions. These
deficiencies can often be corrected with dietary interventions. Therefore, an
important part of treatment is to include a multivitamin with minerals
(particularly calcium).
Anorexia and Vitamin B Complex
Deficiencies in vitamins B2 (riboflavin) and
B6 (pyridoxine) have been noted
in those with anorexia, with some studies suggesting that deficiency of these B
vitamins is present in approximately 20% of anorexic patients admitted to the
hospital for treatment. One small study of 13 people with anorexia found 33% of
the participants were deficient in vitamins B2 and B6 may be deficient in as
many as 33% of those with this eating disorder. Dietary changes alone, without
additional supplements, often can bring vitamin B levels back to normal.
Anorexia and Antioxidants
Inadequate intake of calories, protein, and micronutrients over a prolonged
period of time, as seen in people with anorexia, may cause oxidative stress,
particularly when coupled with excessive physical activity. Oxidative stress is
a process in which certain substances in the body generated from metabolism
(breakdown of tissue for energy) cause cell damage. Antioxidants, such as
vitamins A,
C, and
E, are substances that can help protect the body from the
damage of oxidative stress. In a study comparing antioxidant levels in healthy
female adolescents to those with anorexia, researchers found that the anorexic
group had reduced amounts of these protective substances, such as vitamin E, and
that the antioxidants were not as active in the blood as they normally would be.
It is unclear, however, whether supplementation with antioxidants including
vitamins E and C, beta-carotene, coenzyme Q10, and selenium will correct
deficiencies in people with anorexia or improve their treatment in any way.
Currently, supplementation with antioxidants is not part of standard care for
anorexia, but is being explored scientifically.
Anorexia and Zinc
Zinc influences appetite, taste, smell, vision, and cognitive function and is
an essential nutrient for protein synthesis, growth, and wound healing. The
symptoms of zinc deficiency include loss of appetite, weight loss, skin
abnormalities, lack of menstruation, and depression. Studies have revealed that
zinc deficiencies are common in those with anorexia nervosa and may contribute
to a number of the symptoms of the condition.
Zinc supplementation has demonstrated the following benefits in anorexics:
- Restoring normal zinc levels
- Increasing the rate of weight gain
While zinc supplementation may be helpful as an addition to standard
treatment for anorexia, there are a number of different forms of zinc and more
research is needed to determine which is most effective and at what dosage.
Anorexia and DHEA (Dehydroepiandrosterone)
Women with anorexia nervosa are at increased risk for bone fractures and can
develop osteoporosis at a younger age than women without eating disorders. It
has been observed that adolescents and young adults with anorexia nervosa tend
to have low levels of
DHEA, a hormone produced by the adrenal glands. This is
important because DHEA levels have been associated with bone mineral density,
suggesting that this hormone may play a role in preventing bone loss and
stimulating bone formation. Some preliminary studies suggest that women with
anorexia who take 50 mg of DHEA per day are able to restore normal levels of
this and other hormones, such as estrogen and testosterone, and show signs of
protection from bone loss.
Anorexia and EFAs (Essential Fatty Acids)
Polyunaturated fatty acids (PUFAs), such as
gamma-linolenic acid (an
omega-6
fatty acid) and alpha-linolenic acid (an
omega-3 fatty acid), are essential for
normal growth and development. They are not made by the body and must therefore
be obtained through the diet. Studies suggest that women, and possibly men, with
anorexia nervosa have lower than optimal levels of PUFAs and display
abnormalities in the use of these fatty acids in the body. To prevent the
metabolic complications associated with essential fatty acid deficiencies, some
recommend that treatment programs for anorexia nervosa include PUFA-rich foods
such as organ meats and fish.
Anorexia and Melatonin
Melatonin is a hormone produced in the brain that regulates sleep. Studies
show that fluctuations in melatonin levels may influence the symptoms of
anorexia. For example, abnormally high melatonin levels may cause depressed mood
and daytime sleepiness in those with anorexia. While people with restricting
type of anorexia usually have normal melatonin levels, studies have found that
those with binge and purge anorexia, and anorexia in combination with depression
have abnormal fluctuations and levels of melatonin. Melatonin levels may play a
role in the symptoms of anorexia, but it is not known whether supplementation
will change the course of the disease. Some researchers speculate, however, that
melatonin levels in people with anorexia may indicate who is likely to benefit
from antidepressant medications.
continue: Herbs, Acupuncture, Homeopathy, Massage, Aromatherapy .
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Reviewed: 03/2006
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