Continuing Research, Emerging Treatments Hold Promise for Treating Anorexia Nervosa

Only one study investigated comparative effectiveness of different feeding regimes in teens and found a higher-energy regime (1200 kcals/day instead of 500 kcals/day) prompted more weight gain. Among adults, a few studies explored the potential benefit of skills training workshops, but findings only weakly suggested they may help.

No new medication trials for teens were published, although one on aripiprazole is ongoing. For adults, one trial found no benefit for quetiapine, but findings from a currently unpublished randomized controlled trial suggested improved weight gain from olanzapine.

Emerging Treatments for Teens and Adults

The updated evidence review by Brockmeyer et al reported on 11 published and 20 ongoing trials studying emerging treatments for the disorder. The therapy type that attracted the most research interest, with 5 trials, was cognitive remediation therapy (CRT), aimed at improving “basic cognitive functions by using a range of exercises designed to strengthen cognitive flexibility and holistic information processing and meta-cognitive elements.”

A pair of these studies showed short-term improvement in neurocognition, hinting that CRT may help those with anorexia nervosa improve the neural mechanisms that contribute to poor cognitive flexibility.

A handful of trials with substantial limitations (small size, uncontrolled, and/or unpublished) explored potential benefits from 2 types of exposure therapy: exposure to illness-related stimuli such as food and exercise and exposure to body image (such as through virtual reality) to target fear and anxiety related to the body. Some improvements occurred in mood, self-esteem, and symptoms related to body image, but the findings are very preliminary.

Some new research, albeit mostly case studies, explored neuromodulation treatments, including deep brain stimulation, repetitive transcranial current stimulation, transcranial direct current stimulation, and neurofeedback.

“Neuromodulation treatments have huge potential, both as probes of illness mechanisms and as potential interventions in the treatment of anorexia nervosa, but much of this potential is waiting to emerge,” the authors wrote.

The only new medications undergoing preliminary consideration are oxytocin, fish oils, and dronabinol, a cannabinoid receptor agonist for potentially increasing appetite.

Overall, the review authors expressed optimism about the direction of research into treatments for anorexia nervosa.

“A paradigm shift is occurring away from traditional talking therapies toward a range of novel targeted treatments, thus a transformation of the treatment landscape is taking place,” the authors wrote.

“Whilst we are still a long way away from delivering personally tailored mechanism-based precision treatments for anorexia nervosa, the development of neurotechnologies for diagnosis, outcome prediction, and treatment gives rise to considerable optimism for the future of people with this devastating illness.”

Reference

Brockmeyer T, Friederich H, Schmidt U. Advances in the treatment of anorexia nervosa: a review of established and emerging interventions [published online September 11, 2017]. Psychol Med. doi:10.1017/S0033291717002604