Abstract
Background
The use of valproate in the treatment of Anorexia Nervosa (AN) in children and adolescents is currently not recommended by clinical guidelines, due to lack of evidence. Nonetheless, valproate is used to treat a series of psychiatric and neurologic conditions. To date, only six cases of patients with Feeding and Eating Disorders (three with AN) have been described.
Methods
Case series of 14 children and adolescent patients hospitalized for AN and treated with valproate as an adjunctive treatment. Reasons for introduction, dosages, plasma levels, adverse drug reactions (ADR) and modifications of liver enzymes, platelets levels, abdominal and pelvic ultrasounds, and concurrent drugs plasma levels were assessed.
Results
Reasons for the introduction of valproate included unstable mood (57.1%), lack of compliance (50%) and aggressive behaviour (21.4%). In 71.4% of patients an improvement on target symptoms was observed. Valproate was started at 241.7 (± 73.3) mg, up to 521.4 (± 204.5) mg; the most frequent scheme was twice-daily. The mean plasmatic concentration was 66.3 (± 25.0) mg/L. One patient (7.1%) experienced side effects (somnolence). No major modifications of liver enzymes, platelet levels, abdominal and pelvic ultrasounds emerged after the introduction of valproate. Low concurrent olanzapine and quetiapine levels were documented.
Conclusions
This is the largest sample of patients with AN treated with valproate. Valproate was administered to improve psychiatric symptoms impairing compliance with inpatient treatment programs. The majority of patients experienced an improvement on target symptoms after being administered valproate, with minor ADR. These data should be investigated in wider populations and controlled studies.
Level of evidence
Level IV, case series.
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Availability of data and materials
The data sets used and analysed during the current study are available from the corresponding author on reasonable request.
References
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Author, Arlington, VA
Couturier J, Isserlin L, Norris M, Spettigue W, Brouwers M, Kimber M, McVey G, Webb C, Findlay S, Bhatnagar N, Snelgrove N, Ritsma A, Preskow W, Miller C, Coelho J, Boachie A, Steinegger C, Loewen R, Loewen T, Waite E, Ford C, Bourret K, Gusella J, Geller J, LaFrance A, LeClerc A, Scarborough J, Grewal S, Jericho M, Dimitropoulos G, Pilon D (2020) Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord 1(8):4. https://doi.org/10.1186/s40337-020-0277-8
McElroy SL, Guerdjikova AI, Martens B, Keck PE Jr, Pope HG, Hudson JI (2009) Role of antiepileptic drugs in the management of eating disorders. CNS Drugs 23(2):139–156. https://doi.org/10.2165/00023210-200923020-00004 (PMID: 19173373)
Prescriber’s Guide (2017) Stahl’s essential psychopharmacology. Stephen M. Stahl. Cambridge University Press
https://www.ema.europa.eu/en/documents/referral/valproate-article-31-referral-new-measures-avoid-valproate-exposure-pregnancy-endorsed_en-0.pdf. Accessed 15 May 2021
Harden CL, Herzog AG, Nikolov BG, Koppel BS, Christos PJ, Fowler K, Labar DR, Hauser WA (2006) Hormone replacement therapy in women with epilepsy: a randomized, double-blind, placebo-controlled study. Epilepsia 47(9):1447–1451. https://doi.org/10.1111/j.1528-1167.2006.00507.x (PMID: 16981859)
Tor PC, Lee EL (2008) Treatment emergent mania responding to valproate in a Chinese female adolescent population with eating disorders: a case series. Eur Eat Disord Rev 16(6):421–426. https://doi.org/10.1002/erv.877
Herridge PL, Pope HG Jr (1985) Treatment of bulimia and rapid-cycling bipolar disorder with sodium valproate: a case report. J Clin Psychopharmacol 5(4):229–230 (PMID: 3926833)
Pruccoli J, Solari A, Terenzi L, Malaspina E, Angotti M, Pignataro V, Gualandi P, Sacrato L, Cordelli DM, Franzoni E, Parmeggiani A (2021) Autism spectrum disorder and anorexia nervosa: an Italian prospective study. Ital J Pediatr 47(1):59. https://doi.org/10.1186/s13052-021-01006-7
Chaer R, Nakouzi N, Itani L, Tannir H, Kreidieh D, El Masri D, El Ghoch M (2020) Fertility and reproduction after recovery from anorexia nervosa: a systematic review and meta-analysis of long-term follow-up studies. Diseases 8(4):46. https://doi.org/10.3390/diseases8040046
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AP and JP reviewed literature data, collected and analysed the data, wrote the manuscript, and revised the manuscript.
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All procedures performed in this study involving human participants were in accordance with the Human Research Ethics Committee of the University of Technology Sydney (UTS) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approval was obtained from the local Ethical Committee prior to conducting this research.
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Pruccoli, J., Parmeggiani, A. Inpatient treatment of anorexia nervosa with adjunctive valproate: a case series of 14 young and adolescent patients. Eat Weight Disord 27, 1209–1215 (2022). https://doi.org/10.1007/s40519-021-01260-y
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DOI: https://doi.org/10.1007/s40519-021-01260-y