Morris Rebecca, Keeler Johanna, Treasure Janet, Himmerich Hubertus
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Pharmacol Res. 2025 Jun;216:107782. doi: 10.1016/j.phrs.2025.107782. Epub 2025 May 14.
People with eating disorders experience high rates of psychiatric comorbidities, including anxiety disorders such as generalised anxiety disorder, social anxiety disorder and specific phobias. Anxiety can influence the prognosis of an eating disorder, by worsening symptoms, and acting as a barrier to treatment. Therefore, targeting treatment efforts towards anxiety may improve eating disorder outcomes. The primary aim of this systematic review was to summarise the evidence base for the pharmacological treatment of anxiety symptoms in people with eating disorders. An electronic search of three databases (PubMed, Medline, and PsycInfo) was conducted. Papers were included if they investigated pharmacotherapy (antidepressants, antipsychotics, antianxiety, psychedelics, etc.) in eating disorder samples, with primary or secondary outcomes of anxiety. A total of 51 studies were included, and results were mixed across drug classes documenting both favourable and non-significant anxiety outcomes. There was evidence for the use of fluoxetine for anxiety in anorexia and bulimia nervosa, but not for binge eating disorder. Evidence for the use of olanzapine was documented for anxiety in AN, and preliminary case reports suggested its use in ARFID for anxiety symptoms. Preliminary evidence for developing pharmacological agents, such as psilocybin and ketamine, reported favourable outcomes in AN patients. More RCTs are required to explore efficacy and safety of pharmacological agents in treating anxiety in people with eating disorders.
饮食失调患者的精神共病发生率很高，包括焦虑症，如广泛性焦虑症、社交焦虑症和特定恐惧症。焦虑会通过加重症状和成为治疗障碍来影响饮食失调的预后。因此，针对焦虑进行治疗可能会改善饮食失调的结果。本系统评价的主要目的是总结饮食失调患者焦虑症状药物治疗的证据基础。对三个数据库（PubMed、Medline和PsycInfo）进行了电子检索。如果论文在饮食失调样本中研究了药物治疗（抗抑郁药、抗精神病药、抗焦虑药、迷幻药等），且焦虑为主要或次要结局，则纳入该论文。共纳入51项研究，不同药物类别的结果不一，既有有利的焦虑结局，也有不显著的焦虑结局。有证据表明氟西汀可用于治疗神经性厌食症和神经性贪食症的焦虑，但对暴饮暴食症无效。有文献记载奥氮平可用于治疗神经性厌食症的焦虑，初步病例报告表明其可用于治疗回避性/restrictive食物摄入障碍的焦虑症状。初步证据表明，诸如裸盖菇素和氯胺酮等药物制剂在神经性厌食症患者中显示出良好疗效。需要更多随机对照试验来探索药物制剂治疗饮食失调患者焦虑的疗效和安全性。
