Drug Prescribing in Child and Adolescent Eating Disorder Services

Background: Psychotropic drugs are not recommended for child and adolescent eating disorders, though they are used empirically for symptomatic treatment and co-morbid conditions. Little is known about rates of prescribing or the beneficial and adverse effects. Objective: To ascertain rates and outcomes of psychotropic drug prescribing in child and adolescent eating disorder services. Method: Retrospective case note study of eating disorder cases (n = 308), seen in one year in seven specialist UK services, covering indications, response to treatment, beneficial and adverse effects. Results: Drugs were prescribed for 27%, (mainly anorexia nervosa), 12% before referral to specialist services. The most commonly prescribed drugs were fluoxetine and olanzapine, but 26 different drugs were used. The most common indications were depression, anxiety and 'pseudo-psychotic' concerns about weight. Drugs were generally well tolerated, but their effectiveness was uncertain. Conclusions: Non-specialists commonly prescribe psychotropic medication to this vulnerable group without reference to specialist services. Specialists prescribe regularly on empirical grounds, without apparent undue consequences, though these may be under-reported. A prospective clinical trial would further clarify risks and benefits. Key Practitioner Message: • Guidelines do not recommend the use of psychotropic drugs as first line treatments for child and adolescent eating disorders. • Nevertheless drugs are often prescribed on symptomatic grounds, in Primary Care and General CAMHS and more commonly by specialist eating disorder services. • Despite concerns about physical health, psychotropic drugs appear to be tolerated well, though adverse effects may be under-reported. • Antidepressants and major tranquillisers are considered by clinicians to often have beneficial effects on the symptoms they target, though other concurrent treatments may confound these impressions.