Novel treatments for anorexia nervosa: Insights from neuroplasticity research

Treatment for anorexia nervosa remains challenging due to limited approved medications and variable psychotherapy effectiveness. Converging evidence indicates deficiencies in neuroplasticity during acute stages of the disorder. This review covers neuroimaging, neuropsychological, molecular, and qualitative findings on neuroplasticity in anorexia nervosa. Novel pharmacological approaches that may address these deficits include ketamine, psilocybin, and human recombinant leptin; anti-inflammatory drugs and brain-derived neurotrophic factor mimetics might become viable after further research. Psychotherapeutic strategies targeting neuroplastic deficiencies and broader identity issues include imagery rescripting, memory specificity training, cognitive remediation therapy, exposure therapies, narrative therapies, cultural interventions, and yoga or mindfulness-based approaches. Longitudinal studies with large samples and feasibility trials are needed to advance translation.

Study at a glance

Abstract

Abstract Objective Treatment 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. Method This 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. Results Novel 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. Conclusions Treatments 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.