The pharmacological treatment of eating disorders: new guidelines and gender-specific aspects

Even though psychopharmacology has made substantial progress in many areas of psychiatry since the discovery of antipsychotics and antidepressants in the 1950s, the evidence base for pharmacological treatments in the field of eating disorders has been lagging. The World Federation of Societies of Biological Psychiatry guidelines update 2023 on the pharmacological treatment of eating disorders provides a comprehensive summary of pharmacological studies and recommendations for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant restrictive food intake disorder, pica and rumination disorder. However, there are very few studies in adolescents, implying that evidence-based recommendations in this population are difficult to make. Gender-specific aspects have also been addressed in the guidelines update, such as the small number of male patients included in pharmacological studies in AN and BN. Furthermore, the guidelines recommend against the treatment of female AN patients with testosterone, mention that topiramate for the treatment of BN and BED is contraindicated during pregnancy and that fluoxetine and its metabolite norfluoxetine inhibit the metabolism of the anti-breast cancer prodrug tamoxifen to its active metabolite endoxifen.