DRUG THERAPY FOR ANOREXIA NERVOSA: ANTIPSYCHOTIC MEDICATIONS
At one time people thought anorexia might be a form of schizophrenia. We know now, of course, that they are completely different disorders, although in rare cases a person may suffer from both at the same time. An anorexic doesn’t usually have the hallucinations commonly seen in schizophrenia. One primary anorexic symptom – feeling fat when actually being very thin – comes close to being a delusion. However, whereas an anorexic can usually see the difference between her body and that of someone who weighs two hundred pounds, a schizophrenic may not be able to make such a distinction.
About thirty years ago, doctors began treating anorexics with chlorpromazine, more commonly known as Thorazine, an antipsychotic drug used in the treatment of schizophrenia. Although these patients did gain a little more weight, their illness didn’t improve over the long term. What’s more, compared to a control group, a higher percentage of patients on Thorazine developed bulimia. It also took longer for their menstrual periods to return. Although some doctors continue to prescribe Thorazine, its popularity has dropped off substantially.
These medications may perhaps have some particular use for certain very small groups of patients: those who are extremely anxious or who are obsessive-compulsive. Another group may benefit from the drugs’ sedating effects, especially very restless patients who, because of their severe medical condition, must be confined to their beds.
Antipsychotics can cause weight gain, a side effect that, in anorexia anyway, is actually desirable. However, antipsychotic medicines have many drawbacks: lowered blood pressure, the risk of seizures, delayed return of menstruation. These drugs are notorious for causing long-term or even permanent neurologic damage, such as the involuntary muscle movements known as tardive dyskinesia.
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