Novel treatments for anorexia nervosa: Insights from neuroplasticity research

ObjectiveTreatment for anorexia nervosa (AN) remains challenging; there are no approved psychopharmacological interventions and psychotherapeutic strategies have variable efficacy. The investigation of evidence-based treatments has so far been compounded by an underdeveloped understanding into the neurobiological changes associated with the acute stages of AN. There is converging evidence of deficiencies in neuroplasticity in AN.MethodThis paper provides an overview of neuroimaging, neuropsychological, molecular and qualitative findings relating to neuroplasticity in AN, translating these findings to the identification of novel biological and psychotherapeutic strategies.ResultsNovel psychopharmacological approaches that may ameliorate deficiencies in neuroplasticity include medications such as ketamine, psilocybin and human recombinant leptin. Anti-inflammatory medications and brain-derived neurotrophic factor mimetics may emerge as potential treatments following further research. Psychotherapeutic strategies that may target neuroplastic deficiencies, as well as having wider effects on identity, include imagery rescripting, memory specificity training, cognitive remediation therapy, exposure therapies, narrative therapies, cultural interventions (e.g. music and arts therapies) and yoga/mindfulness-based interventions.ConclusionsTreatments specifically targeted towards mitigating the neurobiological sequalae of AN are warranted, and emerging neurobiological and neuropsychological research utilising longitudinal designs and large sample sizes, as well as initial feasibility studies, are necessitated to bolster translational efforts. There is converging evidence from neuroimaging, neuropsychological, molecular and qualitative research suggestive of altered neuroplasticity during the acute stages of anorexia nervosa (AN), which is also a transdiagnostic feature across psychiatric disorders.Novel pharmacological treatments that are used for the treatment of other conditions in humans, and could be applied to target neuroplasticity in AN, include ketamine, psilocybin, human recombinant leptin and anti-inflammatory medications.Psychotherapeutic strategies that may target neuroplastic deficiencies in AN, some of which have already been investigated, include those targeting cognitive problems or biases (e.g. imagery rescripting, memory specificity training, cognitive remediation therapy (CRT)), fear (e.g. exposure-based therapies), stress (e.g. yoga/mindfulness-based interventions) and identity (e.g. narrative therapies, cultural interventions such as arts and music-based therapies).

Automated summary

Treatment for anorexia nervosa remains challenging, with no approved psychopharmacological interventions and variable efficacy of psychotherapeutic strategies. Current evidence suggests deficiencies in neuroplasticity in anorexia nervosa, and this paper provides an overview of neuroimaging, neuropsychological, molecular, and qualitative findings in this area. The findings can be translated into the identification of novel biological and psychotherapeutic strategies to improve the treatment outcomes.