Mitchell J E, de Zwaan M, Roerig J L
The Neuropsychiatric Research Institute, 700 1st Avenue So., P.O. Box 1415, Fargo, ND 58107, USA.
Curr Drug Targets CNS Neurol Disord. 2003 Feb;2(1):17-29. doi: 10.2174/1568007033338850.
The purpose of this article is to review the psychopharmacology treatment literature for patients with eating disorders including bulimia nervosa, anorexia nervosa and binge eating disorder. The best-developed treatment literature concerns bulimia nervosa, which has been studied now in several dozen pharmacological treatment studies. The agents most commonly used are the antidepressants, with particular focus on the selective serotonin reuptake inhibitors including fluoxetine hydrochloride. These agents clearly impact significantly on the frequency of abnormal eating behaviors such as binge eating and purging. However, subjects treated with these drugs rarely achieve remission. Pharmacotherapy of anorexia nervosa has also traditionally focused on the use of antidepressants and there is some evidence that the use of SSRIs may help in preventing relapse in weight restored patients. Recently interest has developed in the use of atypical neuroleptics to help with the obsessionality and resistance to treatment frequently seen in low weight patients, the most commonly employed agent being olanzapine. Pharmacotherapy of binge-eating disorder is now being intensively investigated. In general medication alone seems inferior to psychotherapy in the short term. Antidepressants can increase the amount of weight loss when combined with psychological treatment and also appear to benefit symptoms such as depression. Further data are needed, but a number of drugs appear promising.
本文旨在综述针对饮食失调患者（包括神经性贪食症、神经性厌食症和暴饮暴食症）的精神药理学治疗文献。目前研究最为充分的治疗文献涉及神经性贪食症，现已开展了几十项药物治疗研究。最常用的药物是抗抑郁药，尤其侧重于选择性5-羟色胺再摄取抑制剂，包括盐酸氟西汀。这些药物对暴饮暴食和催吐等异常饮食行为的频率有显著影响。然而，接受这些药物治疗的患者很少能实现缓解。传统上，神经性厌食症的药物治疗也侧重于使用抗抑郁药，有证据表明，使用选择性5-羟色胺再摄取抑制剂可能有助于防止体重恢复的患者复发。最近，人们开始关注使用非典型抗精神病药来帮助解决体重过低患者常见的强迫观念和治疗抵抗问题，最常用的药物是奥氮平。暴饮暴食症的药物治疗目前正在深入研究中。一般来说，短期内单独使用药物似乎不如心理治疗。抗抑郁药与心理治疗联合使用时可增加体重减轻量，而且似乎对抑郁等症状也有帮助。还需要更多数据，但一些药物看起来很有前景。
