Pharmacotherapeutic strategies for the treatment of anorexia nervosa - novel targets to break a vicious cycle.

Anorexia nervosa has one of the highest mortality rates among mental illnesses, yet no approved pharmacological treatments exist. This narrative review examines traditional pharmacotherapy and novel treatments—including dissociative anesthetics, psychedelics, cannabinoids, hormones, neurosteroids, and ketogenic nutrition—for altering neurobiology and behavior. The authors recommend a neuroscience-based medication approach targeting dopamine receptors to enhance cognitive flexibility and reduce food-related dread when psychotherapy fails. Treating comorbid anxiety, depression, and obsessive-compulsive disorder is essential, as these conditions persist even after successful anorexia treatment. Novel strategies show promise for improving mood and reducing specific anorexia psychopathology and may soon enter clinical practice.

Study at a glance

Abstract

Anorexia nervosa (AN) has one of the highest mortality rates of all mental illnesses. No approved pharmacological treatments exist for AN, but novel neurobiological targets show promise. Studies show that in individuals with AN, there are alterations in brain neurotransmitter signaling, alongside associated mental rigidity and comorbid anxiety and depression. Available and new therapies could be used to improve alterations in neurobiology and behavior. This narrative review serves as a review of previously published literature assessing the efficacy of traditional pharmacotherapy in treating AN while also exploring novel treatments, including dissociative anesthetics, psychedelics, cannabinoids, hormones, neurosteroids, and ketogenic nutrition. If best practice psychotherapeutic interventions have failed, we recommend a neuroscience and brain research-based medication approach that targets dopamine neurotransmitter receptors to enhance cognitive flexibility and illness insight while reducing dread and avoidance toward food. It is furthermore essential to recognize and treat comorbid conditions such as anxiety, depression, or obsessive-compulsive disorder as they interfere with recovery, and typically do not resolve even with successful AN treatment. Novel strategies have the promise to show efficacy in improving mood and reducing specific AN psychopathology with hopes to be used in clinical practice soon.