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.The comprehensive and discerning review of de Zwaan and Roerigdocuments that in several instances these theoretical advantages have ledto substantial advances, whereas in others the evidence for the utility ofpharmacological intervention remains impressively thin.A major success has been the demonstration of the utility of antidepres-sant medication in the treatment of bulimia nervosa.One of the tables of deZwaan and Roerig s review lists over 20 controlled trials of this class ofagent, and the accumulated data leave no doubt that antidepressantmedication is a useful intervention that has a place in the treatment of thissyndrome.Furthermore, the relative ease of use and low frequency of side-effects of the selective serotonin reuptake inhibitors (SSRIs) make thisintervention widely available, even in non-specialist settings.But, as deZwaan and Roerig appropriately note, the results of a single course ofantidepressant treatment are often disappointing: only a minority ofpatients achieve remission with such treatment.Furthermore, the informa-tion base concerning what pharmacological interventions are clearly usefulas second-line treatments is disappointingly small.Having extensivelyexamined antidepressants, the field has begun only tentatively to explorenovel interventions, such as sibutramine, ondansetron and topiramate, andsuch innovation is overdue.More recent studies of binge eating disorder have attempted to extend themodel of bulimia nervosa to this newly defined entity.There are good1New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive (Unit 98),New York, NY 10032, USA 298 ___________________________________________________________________________ EATING DISORDERSindications that pharmacotherapy has a role to play in the treatment ofbinge eating disorder, but this area of study is still in a relatively early stageof development.The non-specific psychological difficulties associated withbinge eating disorder, such as depression, are generally less extreme thanthose associated with bulimia nervosa, and, by definition, individuals withbinge eating disorder do not regularly engage in inappropriate compensa-tory behaviour, such as vomiting.Nonetheless, studies of pharmacologicaltreatment have encountered some challenges not characteristic of the trialsin bulimia nervosa.First, as de Zwaan and Roerig point out, most patientswith binge eating disorder hope not only to eliminate their binge eating andto improve their sense of psychological well-being, but also to lose weight.The pharmacological treatments examined to date have had difficulty inaddressing all three aims.In addition, the magnitude of the response ofindividuals with binge eating disorder to non-specific interventions,including the use of placebo, may be substantial, complicating the detectionof the effects of medication.More work is needed, and fortunately alreadyis underway.Most investigators will concur wholeheartedly with the description of thestate of pharmacotherapy for anorexia nervosa as   disappointing .Thenumber of trials remains small, and the work to date has not yieldedimpressively effective interventions.The oldest of eating disorders remainsthe most challenging to treat.New efforts have begun recently, some usingmedications to prevent relapse after patients have gained weight and othersexamining the utility of atypical antipsychotic agents, which can beassociated with substantial weight increases.Hopefully, these and othernew ideas will be fruitful, because progress in the pharmacotherapy ofanorexia nervosa is long overdue.REFERENCE1.Smith G.P.(2000) The controls of eating: a shift from nutritional homeostasis tobehavioral neuroscience.Nutrition, 16: 814 820. PHARMACOLOGICAL TREATMENT: COMMENTARIES ______________________________ 2994.5Medicating Disordered Eating: Moving Toward the Next Generation ofStudiesMichael J.Devlin1The goal of developing pharmacological interventions for patients sufferingfrom the complex clusters of nutritional, psychological and behaviouralsymptoms known as the eating disorders is, in many ways, a humbling one [ Pobierz całość w formacie PDF ]

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