Anorexia and bulimia nervosa: Neurobiology and pharmacotherapy

This review provides an overview of some neurobiological factors that may contribute to the development and maintenance of eating disorders, and the psychopharmacological treatment of anorexia and bulimia nervosa; Various metabolic, physiologic, and neuroendocrine disturbances are associated with bulimia and anorexia nervosa, but it is often not clear whether they represent state or trait markers of the disorders. While most patients with bulimia nervosa who receive appropriate pharmacotherapy will experience significant short-term improvement, there is a substantial rate of relapse during long-term continuation treatment with medication. Strategies that appear to improve long-term outcome in bulimia nervosa include combination treatment with cognitive-behavioral therapy (CBT) and changing to an alternative antidepressant medication. The role for medication treatment in anorexia nervosa remains very limited, although the SSRI antidepressant fluoxetine may have a limited role in longterm treatment of anorexia.