I have met a lot of people, women and men, with anorexia nervosa. The people, not surprisingly, are all different from each other – as people always are. The illness, on the other hand, is always remarkably the same. And, always the same, I want to help. Part of helping, I have learned, is meeting patients where they are to begin moving forward together.
Some people come to me fully energized to make big changes, prepared to postpone any other commitments or obligations to get anorexia nervosa out of their lives. Others arrive so depleted from the illness that they are asking for all of the support possible to help get them on their way to health. For all of these individuals, I know where we start. The process begins with a structured treatment – in a day program, a partial hospital, a residential or inpatient setting – to help people to get eating and to get unstuck from the habits of illness. Intensive, structured, behaviorally-oriented treatment is often successful at helping patients with anorexia nervosa to get re-nourished. At healthier weights, people are well-poised to take on other essential aspects of recovery like the hard work of thinking about their thinking or tackling issues of self-esteem and body image.
But what if the way ahead is less clear from the start? Some people arrive at my office quite clear that the risks of investing in a structured treatment outweigh the benefits, perhaps because of their own internal struggles inherent to the illness, or because of a connection to an outpatient team with whom they’ve worked successfully in the past. There are those who are in the middle of something in their lives (for example, taking care of small children, or nearing completion of a school or work goal) and cannot figure out how to make the time for an intensive approach. And others who have tried all the treatments our field has to offer without much long term success. For these individuals, and more, we — treatment providers—want to learn what will help.
What if a medication treatment could help to lessen the psychological symptoms that become such strong barriers to eating? A medication can be taken every day, without needing to take a break from one’s life. What if a medication could help people stop a trajectory of weight loss and begin to slowly change the balance between energy-in and energy-out so that nourishment could begin? This might help us, patients and clinicians alike, to better appreciate the strides toward health that can be made as an outpatient. What if?
It is in this spirit—wanting to help, knowing that the illness of anorexia nervosa is a consistently tough beast to battle, and aware that the same treatment approach will not fit all—that I became part of a multi-site study to evaluate another outpatient treatment option, a medication. Based on previous research with a small number of people with anorexia nervosa, we have reason to think that a medicine called olanzapine may help people to feel better, and to take steps towards health. Now we are trying to find out for sure. In a large study run by Dr. Evelyn Attia at Columbia University/New York State Psychiatric Institute, in collaboration with Weill Cornell Medical Center, University of Pittsburgh, Johns Hopkins Medical Center, and Toronto’s Center for Addiction and Mental Health, we are learning the value of olanzapine treatment for outpatients with anorexia nervosa.
How are we studying this treatment? In our NIMH-funded study patients come in to see the psychiatrist once a week, where they get expert-level care for anorexia nervosa including psychiatric care, medical monitoring and some nutritional guidance. In addition, they take the study medicine every day. For each person, the study medicine is either olanzapine or placebo (inactive medication, sometimes called a “sugar pill”). We are comparing the active medicine to an inactive medicine to be confident that if patients experience a change in their symptoms, it is because there is actually something in the medication that is making the difference. Neither patients nor clinicians involved in the study (myself included) know who is on the active medication – again, this helps us to better evaluate whether the medicine is truly helpful without any bias. Over the course of 4 months (16 weeks), we are evaluating whether the medicine helps people to feel better, and whether it helps people get better nourished. At the conclusion of the study, patients (but not their doctors) learn what type of pill they have been taking and everyone is then offered a trial of olanzapine, if they wish.
This study – now in its 4th year – offers the opportunity for individuals with anorexia nervosa to try a new treatment and get specialty care while continuing with their everyday lives. It is my hope that the findings from this study will offer me (and other treatment providers) new insights into how to help all of those struggling with anorexia nervosa, regardless of circumstance, to find their way towards health.