Pharmacotherapy, alternative and adjunctive therapies for eating disorders: findings from a rapid review
Authors: Rodan Sarah-Catherine , Bryant Emma , Le Anvi , Maloney Danielle , Touyz Stephen , McGregor Iain S. , Maguire Sarah ,   National Eating Disorder Research Consortium, Aouad Phillip , Barakat Sarah , Boakes Robert , Brennan Leah , Bryant Emma , Byrne Susan , Caldwell Belinda , Calvert Shannon , Carroll Bronny , Castle David , Caterson Ian , Chelius Belinda , Chiem Lyn , Clarke Simon , Conti Janet , Crouch Lexi , Dammery Genevieve , Dzajkovski Natasha , Fardouly Jasmine , Feneley John , Firriolo Amber-Marie , Foroughi Nasim , Fuller-Tyszkiewicz Mathew , Fursland Anthea , Gonzalez-Arce Veronica , Gouldthorp Bethanie , Griffin Kelly , Griffiths Scott , Hambleton Ashlea , Hannigan Amy , Hart Mel , Hart Susan , Hay Phillipa , Hickie Ian , Kay-Lambkin Francis , King Ross , Kohn Michael , Koreshe Eyza , Krug Isabel , Linardon Jake , Long Randall , Long Amanda , Madden Sloane , Maguire Sarah , Maloney Danielle , Marks Peta , McLean Sian , Meddick Thy , Miskovic-Wheatley Jane , Mitchison Deborah , O’Kearney Richard , Hwa Ong Shu , Paterson Roger , Paxton Susan , Pehlivan Melissa , Pepin Genevieve , Phillipou Andrea , Piccone Judith , Pinkus Rebecca , Raykos Bronwyn , Rhodes Paul , Rieger Elizabeth , Rodan Sarah-Catherine , Russell Janice , Russell Haley , Salter Fiona , Sawyer Susan , Shelton Beth , Singh Urvashnee , Smith Sophie , Smith Evelyn , Spielman Karen , Squire Sarah , Thomson Juliette , Touyz Stephen , Utpala Ranjani , Vartanian Lenny , Vatter Sabina , Wallis Andrew , Ward Warren , Wells Sarah , Wertheim Eleanor , Wilksch Simon , Williams Michelle 
Published: July 2023

Abstract
Background
The current review broadly summarises the evidence base for pharmacotherapies and adjunctive and alternative therapies in the treatment of eating disorders and disordered eating.

Methods
This paper forms part of a Rapid Review series examining the evidence base in the field of eating disorders. This was conducted to inform the Australian National Eating Disorder Research and Translation Strategy 2021–2030. ScienceDirect, PubMed and Ovid/Medline were searched for included studies published between 2009 and 2021 in English. High-level evidence such as meta-analyses, large population studies and randomised control trials were prioritised, and grey literature excluded. Data from included studies relating to pharmacotherapy, and to adjunctive and alternative therapies in eating disorders, were synthesised and disseminated in the current review.

Results
A total of 121 studies were identified, relating to pharmacotherapy (n = 90), adjunctive therapies (n = 21) and alternative therapies (n = 22). Some of the identified studies involved combinations of the above (e.g. adjunctive pharmacotherapy). Evidence of efficacy of interventions across all three categories was very limited with few relevant high quality clinical trials. There was a particular scarcity of evidence around effective treatments for anorexia nervosa (AN). With treatment of bulimia nervosa (BN), fluoxetine has exhibited some efficacy leading to regulatory approval in some countries. With binge eating disorder (BED), recent evidence supports the use of lisdexamfetamine. Neurostimulation interventions show some emerging efficacy in the treatment of AN, BN and BED but some, such as deep brain stimulation can be highly invasive.

Conclusion
Despite widespread use of medications, this Rapid Review has identified a lack of effective medications and adjunctive and alternative therapies in the treatment of EDs. An intensification of high-quality clinical trial activity and drug discovery innovation are required to better assist patients suffering from EDs.