Subjective Experience of Antidepressant Prescription Among Adolescents With Anorexia Nervosa

Maude Ludot-Grégoire, Vanille David, Emilie Carretier, Jonathan Lachal, Marie Rose Moro, Corinne Blanchet, Maude Ludot-Grégoire, Vanille David, Emilie Carretier, Jonathan Lachal, Marie Rose Moro, Corinne Blanchet

Abstract

Introduction: Major depressive disorder is considered the most common comorbidity of anorexianervosa in adolescence. Some evidence argues against antidepressant use in this population. Moreover, the fear of being threatened with autonomy and of becoming dependent specific to this adolescent population and at the very core of the anorexic disease, make the proposal of such a treatment difficult to accept. This qualitative research aimed to explore the perspectives of view of adolescents with anorexia nervosa about antidepressants.

Methods: We conducted interviews with adolescents suffering from anorexia nervosa who had been treated with an antidepressant agent during their inpatient or outpatient care at Cochin Hospital. Adolescents were chosen by convenience sampling. Both verbal and written questions were asked to elicit their lived experiences. Interpretative Phenomenological Analysis was used to examine the data.

Results: Fifteen adolescents (13 girls and two boys) were interviewed. We have reached total data saturation. The analysis found two meta-themes, each with two separate themes. (I) Reactions to the proposal of antidepressant with (i) an opposition phase (about the existence of depressive symptoms and about negative preconceptions) and (ii) need to share with family and other teenagers. (II) Reactions to antidepressant use with (iii) ambivalence and an initial perception of coercion, and (iv) effects of antidepressants (psychological effects, effects on the body and on anorexia nervosa and effects perceived through the eyes of others).

Discussion: Despite positive effects, ambivalence toward the treatment remained present throughout the interviews: these adolescents still worry greatly about loss of control and weight gain. Depression as comorbidity seems to be entangled in the denial of disease, cognitive distortion and acquired fearlessness specific to AN. Its existence in adolescence can uncover transgenerational issues, sometimes previously hidden. An orodispersible/drinkable form of antidepressants would facilitate adherence to treatment in this specific population. The intervention of a "patient-expert" could reduce adolescents' anxiety about loss of control. A latency period seems necessary to allow them to understand the prescription at their own level and in the complexity of their anorexic illness.

Keywords: adolescence; anorexia nervosa; antidepressant agent; major depressive disorder; qualitative research.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Ludot-Grégoire, David, Carretier, Lachal, Moro and Blanchet.

References

    1. Diagnosis and Statistical Manual of Mental Disorders: DSM-5 . 5th ed. Washington, DC, USA: American Psychiatric Association; (2013).
    1. Godart N, Perdereau F, Jeammet P. Données épidémiologiques: anorexie chez l'adolescent. J Pédiatrie Puériculture. (2004) 17:327–30. 10.1016/j.jpp.2004.06.006
    1. Kostev K, Teichgräber F, Konrad M, Jacob L. Association between chronic somatic conditions and depression in children and adolescents: a retrospective study of 13,326 patients. J Affect Disord. (2019) 245:697–701. 10.1016/j.jad.2018.11.014
    1. Jaite C, Hoffmann F, Glaeske G, Bachmann CJ. Prevalence, comorbidities and outpatient treatment of anorexia and bulimia nervosa in German children and adolescents. Eat Weight Disord. (2013) 18:157–65. 10.1007/s40519-013-0020-4
    1. Bühren K, Schwarte R, Fluck F, Timmesfeld N, Krei M, Egberts K, et al. . Comorbid psychiatric disorders in female adolescents with first-onset anorexia nervosa: comorbidity in adolescent anorexia nervosa. Eur Eat Disord Rev. (2014) 22:39–44. 10.1002/erv.2254
    1. Marucci S, Ragione LD, De Iaco G, Mococci T, Vicini M, Guastamacchia E, et al. . Anorexia Nervosa and Comorbid Psychopathology. Endocr Metab Immune Disord Drug Targets. (2018) 18:316–24. 10.2174/1871530318666180213111637
    1. Thornton LM, Welch E, Munn-Chernoff MA, Lichtenstein P, Bulik CM. Anorexia nervosa, major depression, and suicide attempts: shared genetic factors. Suicide Life Threat Behav. (2016) 46:525–34. 10.1111/sltb.12235
    1. Frank G, Shott ME, DeGuzman MC. Recent advances in understanding anorexia nervosa. F1000Research. (2019) 8:504. 10.12688/f1000research.17789.1
    1. Frank G. Pharmacotherapeutic strategies for the treatment of anorexia nervosa-too much for one drug? Expert Opin Pharmacother. (2020) 21:1045–58.
    1. Leblé N, Radon L, Rabot M, Godart N. Depressive symptoms during anorexia nervosa: state of the art and consequences for an appropriate use of antidepressants. L'Encéphale. (2017) 43:62–8. 10.1016/j.encep.2016.02.017
    1. Torres S, Guerra MP, Lencastre L, Miller K, Vieira FM, Roma-Torres A, et al. . Alexithymia in anorexia nervosa: the mediating role of depression. Psychiatry Res. (2015) 225:99–107. 10.1016/j.psychres.2014.10.023
    1. Balestrieri M, Oriani MG, Simoncini A, Bellantuono C. Psychotropic drug treatment in anorexia nervosa. Search for differences in efficacy/tolerability between adolescent and mixed-age population. Eur Eat Disord Rev. (2013) 21:361–73. 10.1002/erv.2240
    1. Harrington BC, Jimerson M, Haxton C, Jimerson DC. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician. (2015) 91:46–52.
    1. DiVasta AD, Feldman HA, O'Donnell JM, Long J, Leonard MB, Gordon CM. Effect of exercise and antidepressants on skeletal outcomes in adolescent girls with anorexia nervosa. J Adolesc Health. (2017) 60:229–32. 10.1016/j.jadohealth.2016.10.003
    1. Carretier E, Blanchet C, Moro MR, Lachal J. Comorbid major depressive disorder of anorexia nervosa in adolescence: a scoping review of treatment strategies. Encéphale. (2020) 47:72–8. 10.1016/j.encep.2020.05.017
    1. Couturier J, Isserlin L, Norris M, Spettigue W, Brouwers M, Kimber M, et al. . Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord. (2020) 8:32. 10.1186/s40337-020-00307-2
    1. Beykloo MY, Nicholls D, Simic M, Brauer R, Mills E, Wong I. Survey on self-reported psychotropic drug prescribing practices of eating disorder psychiatrists for the treatment of young people with anorexia nervosa. BMJ Open. (2019) 9:e031707. 10.1136/bmjopen-2019-031707
    1. Walsh BT, Kaplan AS, Attia E, Olmted M, Parides M, Carter JC, et al. . Fluoxetine after restoration in anorexia nervosa: a randomized controlled trial. JAMA. (2006) 295:2605–12. 10.1001/jama.295.22.2605
    1. Blanchet C, Guillaume S, Bat-Pitault F, Carles ME, Clarke J, Dodin V, et al. . A multidisciplinary overview of meta-analyses and systematic reviews. J Clin Med. (2019) 8:278. 10.3390/jcm8020278
    1. Misra M, Klibanski A. Anorexia nervosa and its associated endocrinopathy in young people. Horm ResPaediatr. (2016) 85:147–57. 10.1159/000443735
    1. Davis H, Attia E. Pharmacotherapy of eating disorders. Curr Opin Psychiatry. (2017) 30:452–7. 10.1097/YCO.0000000000000358
    1. Drabkin A, Rothman MS, Wassenaar E, Mascolo M, Mehler PS. Assessment and clinical management of bone disease in adults with eating disorders: a review. J Eat Disord. (2017) 5:42. 10.1186/s40337-017-0172-0
    1. Robinson L, Micali N, Misra M. Eating disorders and bone metabolism in women. Curr Opin Pediatr. (2017) 29:488–96. 10.1097/MOP.0000000000000508
    1. Anderson C, Roy T. Patient experiences of taking antidepressants for depression: a secondary qualitative analysis. Res Social and Adm Pharm. (2013) 9:884–902. 10.1016/j.sapharm.2012.11.002
    1. Floersch J, Townsend L, Longhoffer J, Munson M, Winbush V, Kranke D, et al. . Adolescent experience of psychotropic treatment. Transcult Psychiatry. (2009) 46:157–79. 10.1177/1363461509102292
    1. Maroun RA, Thackeray LA, Midgley N. Meaning and medication: a thematic analysis of depressed adolescents' views and experiences of SSRI antidepressants alongside psychological therapies. BMC Psychiatry. (2018) 18:374. 10.1186/s12888-018-1961-y
    1. Antoine P, Smith JA. Saisir l'expérience: présentation de l'analyse phénoménologique interprétative comme méthodologie qualitative en psychologie. Psychologie française Elsevier Masson. (2017) 62:373–85. 10.1016/j.psfr.2016.04.001
    1. Blakemore SJ, Mills KL. Is adolescence a sensitive period for sociocultural processing? Annu Rev Psychol. (2014) 65:187–207. 10.1146/annurev-psych-010213-115202
    1. Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. (2018) 2:223–8. 10.1016/S2352-4642(18)30022-1
    1. Kinghorn A, Shanaube K, Toska E, Cluver L, Bekker LG. Defining adolescence: priorities from a global health perspective. Lancet Child Adolesc Health. (2018) 2:e10. 10.1016/S2352-4642(18)30096-8
    1. Sebaaly JC, Cox S, Hughes CM, Kennedy ML, Garris SS. Use of fluoxetine in anorexia nervosa before and after weight restoration. Ann Pharmacother. (2013) 47:1201–5. 10.1177/1060028013503127
    1. Tindall L, Smith JA, Flower P, Larkin M. Interpretative phenomenological analysis. theory, method and research. Qual Res psychol. (2009) 6:346–7. 10.1080/14780880903340091
    1. Smith JA. Beyond the divide between cognition and discourse:using interpretative phenomenological analysis in health psychology. Psychol Health. (1996) 11:261–71. 10.1080/08870449608400256
    1. Jeammet P, Corcos M. Evolution des problématiques à l'adolescence. L'émergence de la dépendance et ses aménagements Paris: Doin Edition; (2010).
    1. Sibeoni J, Orri M, Valentin M, Podlipski M-A, Colin S, Pradere J, et al. . Metasynthesis of the Views about treatment of anorexia nervosa in adolescents: perspectives of adolescents, parents, and professionals. PLoS ONE. (2017) 12:e0169493. 10.1371/journal.pone.0169493
    1. Zaitsoff S, Pullmer R, Menna R, Geller J. A qualitative analysis of aspects of treatment that adolescents with anorexia identify as helpful. Psychiatry Res. (2016) 238:251–6. 10.1016/j.psychres.2016.02.045
    1. Sibeoni J, Verneuil L, Poulmarc'h L, Orri M, Jean E, Podlipski MA, et al. . Obstacles and facilitators of therapeutic alliance among adolescents with anorexia nervosa, their parents and their psychiatrists: A qualitative study. Clin Child Psychol Psychiatry. (2020) 25:16–32. 10.1177/1359104519882765
    1. Viglione V, Muratori F, Maestro S, Brunori E, Picchi L. Denial of symptoms and psychopathology in adolescent anorexia nervosa. Psychopathology. (2006) 39:255–60. 10.1159/000094723
    1. Babac A, von Friedrichs V, Litzkendorf S, Zeidler J, Damm K, Graf von der Schulenburg JM. Integrating patient perspectives in medical decision making: a qualitative interview study examining potentials within the rare disease information exchange process in practice. BMC Med Inform Decis Mak. (2019) 19:188. 10.1186/s12911-019-0911-z
    1. MacDonald K, Irvine L, Smith MC. An exploration of partnership through interactions between young 'expert' patients with cystic fibrosis and healthcare professionals. J Clin Nurs. (2015) 24:3528. 10.1111/jocn.13021
    1. Griffiths C, Foster G, Ramsay J, Eldridge S, Taylor S. How effective are expert patient (lay led) education programmes for chronic disease? BMJ. (2007) 334:1254–6. 10.1136/bmj.39227.698785.47
    1. Tattersall RL. The expert patient: a new approach to chronic disease management for the twenty-first century. Clin Med. (2002) 2:227–9. 10.7861/clinmedicine.2-3-227
    1. Rohrbach PJ, Dingemans AE, Spinhoven P, Van den Akker-Van Marle E, Van Ginkel JR, Fokkema M et al. A randomized controlled trial of an Internet-based intervention for eating disorders and the added value of expert-patient support: study protocol. Trials. (2019) 20:509. 10.1186/s13063-019-3574-2
    1. Cerea S, Bottesi G, Grisham JR, Ghisi M. Non-weight-related body image concerns and Body Dysmorphic Disorder prevalence in patients with Anorexia Nervosa. Psychiatry Res. (2018) 267:120–5. 10.1016/j.psychres.2018.05.068

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner