Pharmacotherapy of eating disorders: a critical review.

The pharmacotherapy of anorexia nervosa and bulimia are critically reviewed. No chemical treatment has been shown effective for anorexia nervosa. Antidepressants with a low incidence of annoying adverse reactions (e.g., desipramine) may be used as initial drug therapy in patients with concomitant depression. Cyproheptadine also is an attractive agent for initial therapy consideration in anorectics because of its relative safety. Both uncontrolled and controlled trials have found antidepressant drugs effective in bulimia, and they represent the pharmacotherapy of first choice. Alternative drug therapies include anticonvulsants (phenytoin and carbamazepine) and lithium. However, these agents need further controlled trials to substantiate their efficacy.