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Psychotropic medications in adult and adolescent eating disorders: clinical practice versus evidence-based recommendations

Garner, DM, Anderson, ML, Keiper, CD, Whynott, R. Parker, L (2016) Psychotropic medications in adult and adolescent eating disorders: clinical practice versus evidence-based recommendations. Eating and Weight Disorder Journal, First Online 2/1/16

“Let food be thy medicine, thy medicine shall be thy food.” -Hippocrates
“The person who takes medicine must recover twice; once from the disease, and once from the medicine.” -Sir William Osler

Abstract

AIM: Treatment recommendations suggest medication should not be the primary treatment for eating disorders (ED) and empirical evidence demonstrates their ineffectiveness in anorexia nervosa (AN). New study just published from the River Centre Clinic shows that research evidence is rarely followed in prescribing psychotropic drugs to AN patients. The study examined the frequency of psychotropic prescriptions in a clinical sample of eating disorder (ED) patients confirming earlier research indicating their use is very common but inconsistent with evidence-based recommendations.

METHODS: The sample consisted of 501 ED patients admitted to an adult partial hospitalization or adolescent residential program.  Patients were divided into two diagnostic groups: anorexia nervosa (AN= 287) and bulimia nervosa (BN= 214), as well as two age groups: adults (age ≥ 18; N=318) and adolescents (age < 18; N=183).

RESULTS: Forty-one different psychotropic medications (891 prescriptions in all) were prescribed for 429 patients.  Overall, 85.6% of the total sample reported using one or more psychotropic medications. Of 429 patients using any medications, 46.9% were on two or more, 25.3% on three or more, and 11.0% four or more. Antidepressants were most commonly prescribed (89.5% of those on medication) with no significant differences in usage patterns based on diagnosis. However, there was greater medication use among adults (89.6%) compared to adolescents (78.7%).  Results indicate psychotropic medication prescription is more widespread in a clinical sample than in an earlier report screening for osteoporosis in AN women.

DISCUSSION: Treatment recommendations suggest medication should not be the primary treatment for EDs and empirical evidence demonstrates their ineffectiveness in AN. Nevertheless, there were no differences in frequency found between diagnostic groups, confirming little relationship between evidence-based recommendations and actual clinical use for those referred to a specialized ED treatment facility. This study adds new evidence regarding age-based comparisons of psychotropic prescription frequency in clinical EDs and comparison between AN and BN which has not been examined in earlier studies. In sum, the apparent increase in medication use in AN despite data indicating it is ineffective is troubling in light of the breadth and weight of the evidence that has been published on the subject.  There appears to be little relationship between evidence-based practice guidelines for pharmacotherapy and clinical practice as it is conducted in the community.  This study adds to a growing body of research suggesting that mental health professionals tend to base treatment on their training, clinical experience or theoretical orientation rather research evidence.

Link: http://link.springer.com/article/10.1007/s40519-016-0253-0?wt_mc=internal.event.1.SEM.ArticleAuthorOnlineFirst

Or request a copy of the article: garner@river-centre.org