Eshelman School of Pharmacy, University of North Carolina, Chapel Hill.
Ann Pharmacother. 2013 Sep;47(9):1201-5. doi: 10.1177/1060028013503127.
To examine the evidence for the use of fluoxetine in treatment of underweight and weight-restored patients with anorexia nervosa (AN) and provide recommendations for the clinical usefulness of fluoxetine in AN.
Literature was accessed via PubMed through June 2013 using the terms fluoxetine and anorexia nervosa. In addition, reference citations from publications identified were reviewed.
Randomized controlled trials published in English identified from the data sources were evaluated. Studies including the use of fluoxetine in underweight or weight-restored patients with AN were included. Studies of fluoxetine in preclinical animal models of anorexia nervosa were excluded.
AN is a serious psychiatric illness with no currently approved medication therapy. Because patients with AN frequently display symptoms of major depressive and obsessive-compulsive disorders, medication therapy is commonly used in attempts to improve these symptoms and prevent relapses of AN. Antidepressants such as fluoxetine are the most frequently used medications for these symptoms. The evidence for fluoxetine in the treatment of AN is controversial, particularly in patients who remain underweight. One theory of inefficacy is that underweight patients do not have the nutrients required to make serotonin, therefore preventing selective serotonin reuptake inhibitors from taking effect. Another theory involves dysregulation of the serotonin receptor. Despite the lack of evidence, fluoxetine may still be useful in certain underweight and weight-restored patients.
The risk-benefit ratio of fluoxetine in underweight and weight-restored patients with AN is undefined by clinical trials; therefore, clinical experience must be applied for its use in this patient population.
研究氟西汀治疗神经性厌食症（AN）体重不足和体重恢复患者的证据，并为氟西汀在 AN 中的临床应用提供建议。
通过 2013 年 6 月在 PubMed 上使用氟西汀和神经性厌食症这两个术语检索文献，此外，还查阅了已确定出版物的参考文献。
评估了从上述数据源中识别出的英语发表的随机对照试验。纳入了包括氟西汀用于 AN 体重不足或体重恢复患者的研究。排除了氟西汀在神经性厌食症临床前动物模型中的研究。
AN 是一种严重的精神疾病，目前尚无批准的药物治疗方法。由于 AN 患者常伴有重度抑郁和强迫症的症状，因此药物治疗常用于改善这些症状并预防 AN 的复发。氟西汀等抗抑郁药是治疗这些症状最常用的药物。氟西汀治疗 AN 的证据存在争议，特别是在体重不足的患者中。一种无效理论认为，体重不足的患者没有产生血清素所需的营养物质，因此阻止了选择性血清素再摄取抑制剂发挥作用。另一种理论涉及血清素受体的失调。尽管缺乏证据，但氟西汀在某些体重不足和体重恢复的患者中仍可能有用。
氟西汀在 AN 体重不足和体重恢复患者中的风险效益比尚未通过临床试验确定；因此，必须根据临床经验将其用于该患者群体。
