I have to blog light today, but I wanted to write briefly on this article from the SF Chronicle:
Prozac is one of the antidepressants often used to treat anorexia, but researchers found it didn’t stop young women from resuming their self-starving ways.
In a small study, more than half of the women who got Prozac or dummy pills dropped out of the experiment, and few who remained in it kept their weight from dropping into the danger zone. The results underscore the difficulty in curing the troubling eating disorder.
Taken with previous findings, the results indicate the common practice of prescribing antidepressants “is unlikely to provide substantial benefit for most patients with anorexia,” the researchers wrote. Their report was in Wednesday’s Journal of the American Medical Association.
I’m speaking as a layperson here, but this doesn’t surprise me at all. Look: an eating disorder is a kind of coping strategy. All of the stress and pain and fear and other unhappiness in your life gets shifted onto your body. Your body has to be perfected or slimmed down or controlled or otherwise altered. When that happens, everything will get better. (It never does happen, of course, since your goal is never stable and is a ruse anyway, and because the disorder itself creates a great deal of heartache.) For someone with an eating disorder, the connection between pain == bodily imperfection is reflexive. There is nothing to life besides the body and its perceived failures. That’s why eating disorders tend to manifest or worsen at times when the sufferer is under stress for reasons unrelated to the body: a relative’s passing, a tough courseload, a failed relationship.
Therapy for eating disorders involves cutting that circuit, teaching the sufferer how to deal with their suffering in constructive ways rather than fixating on the body. Some of treatment can involve removing or controlling sources of stress, which the sufferer probably has failed to do for however long they’ve been sick. Most of it involves teasing out connections between stress and the body, and training the sufferer out of disordered habits. But as long as the sufferer feels stress, they will deal with the impulse to slide back into disordered behavior. To the extent that they are human beings interacting with the world around them, they will face stress and therefore temptation to cope with that stress in the way to which they’ve become accustomed.
Like they say:
Taken with previous findings, the results indicate the common practice of prescribing antidepressants “is unlikely to provide substantial benefit for most patients with anorexia,” the researchers wrote. Their report was in Wednesday’s Journal of the American Medical Association.
The study follows a research review in April from the government’s Agency for Healthcare Research and Quality, which found that no drug effectively treats anorexia. That report said a few behavior treatments can help, including psychotherapy that encourages patients to develop thinking patterns to counteract their unhealthy eating behavior.
So it makes sense that an antidepressant might partially alleviate unhappiness and therefore partially alleviate the need to engage in disordered behavior, but not solve the connection itself.