Q & A: Citalopram for Anorexia Nervosa

Q: I’ve started doing psychotherapy with a young adolescent with anorexia nervosa who was recently discharged from the hospital. She also has major depression, and her primary care physician has recently put her on Celexa® (citalopram). Is there any evidence that this will help her anorexia nervosa? (D. I., Miami)

A: Although citalopram seems to be a very good selective serotonin-inhibitor type of antidepressant, and has become increasingly popular for outpatient depression because of its favorable side effect profile, the limited published clinical experience describing use of this drug for patients with anorexia nervosa is actually very troubling and worrisome. None of the serotonin reuptake inhibitors (SSRIs), including citalopram, are helpful in the weight restoration phase of anorexia nervosa. In a letter published in the prestigious British journal, The Lancet, investigators reported a clinical trial in adolescent outpatients with anorexia nervosa who were treated with psychotherapy alone or with psychotherapy combined with citalopram. Whereas the group receiving psychotherapy alone didn’t gain weight, those receiving both psychotherapy plus medication actually lost weight, often in the range of 1-2 kg; this was weight they could ill afford to lose since their body mass indexes were still very low (Lancet 1996; 348: 1459). Based on this report, until such time as other data may become available, I would not advise using citalopram in this population. Luckily, there are many other good antidepressants from which to choose.

— J.Y.