Adolescents with restrictive eating disorders had high rates of psychiatric comorbidity and medication use, reported Dr. Maria C. Monge of the division of adolescent/young adult medicine at Boston Children’s Hospital, and her coauthors.
In an analysis of 635 patients (359 of whom had follow-up after 1 year), 20.4% were taking psychopharmacologic medication at intake and 58.7% were taking medication at 1 year (P < .0001). The presence of psychiatric comorbidity was significantly associated with medication use (odds ratio, 10.0).
In 256 patients in which there was additional information about psychopharmacologic medication use, selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) was the most common (83%), followed by anxiolytic (18%), antipsychotic (17%), other antidepressant (15%), mood stabilizer (8%), other psychopharmacologic medication not listed elsewhere (cyproheptadine, gabapentin, and guanfacine; 6%), stimulant (6%), and atomoxetine (1%). A total of 30% of patients on these medications were taking two or more at 1-year follow-up.
At 1-year follow-up, 63% of patients had a psychiatric comorbidity. Anxiety was the most common at 44%, followed by depression in 26%. Less-common diagnoses were attention-deficit/hyperactivity disorder in 2%, bipolar disorder in 0.5%, and other diagnoses in 2% including posttraumatic stress disorder, personality disorder, drug abuse, conversion disorder, trichotillomania, oppositional defiant disorder, and body dysmorphic disorder.
“Psychopharmacologic medications may be appropriate for treatment of comorbid conditions in these patients; however, it is unclear from existing studies if the addition of medication changes patients’ trajectories and provides an effective adjunct to weight restoration,” Dr. Monge and her colleagues said. “Continued investigation is needed to ensure [whether] the desired outcomes of the medications are being met, and the risks and rewards of such medications are fully understood in these patients.”
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