Unfortunately, the few good studies on the use of antidepressants in treating self-starvation have produced nothing like the results seen in bulimia. The specific antidepressants studied so far include clomipramine and amitriptyline. Clomipramine, recently approved for use in this country and sold under the brand name Anafranil, is used to treat obsessive-compulsive disorder, which has some features in common with anorexia. The theory was that the same drug might prove effective in both. So far, however, results have been inconclusive. We need more studies, especially ones looking at the use of clomipramine in higher doses.
If we can one day find the right antidepressant, we may help anorexics in two ways. First, these medications can improve depressed mood. When that happens, the patient’s attitudes may improve not just about eating but about life in general. Second, such drugs may correct the underlying biological malfunctions that produce the symptoms of the disorder.
Depression by itself can cause weight loss. Conversely, weight loss can lead to depression. If her mood improves, fine; no medication is needed. If not, I will think about using an antidepressant. In certain circumstances I may try these products before the patient regains weight if her mood disturbance is severe, or if she engages in compulsive rituals that interfere with her ability to function.
Even so, antidepressants pose risks, such as lowered blood pressure or problems with the way electric signals travel through the heart. One common side effect may be weight gain. As you might expect, an anorexic who is aware of this may resist taking her medication.
Studies on lithium carbonate haven’t shown that it is of much use in treating anorexia. Some reports state that patients gained a little weight and experienced better moods. However, the weight gain may have resulted from salt and water retention, a known side effect of lithium. I wouldn’t use this drug on an anorexic unless she also happened to suffer from manic-depressive illness.
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