A research team led by McGill University, in collaboration with French scientists, has made a significant breakthrough in understanding and potentially treating anorexia nervosa.
This eating disorder, which predominantly affects women, has the highest mortality rate among psychiatric diseases.
The team’s findings, published in Nature Communications, offer hope for millions of sufferers worldwide.
The researchers, working with mice, discovered that a deficit in a brain chemical called acetylcholine in the striatum—an area linked to the brain’s reward system—can lead to the compulsive self-starvation seen in anorexia nervosa.
This discovery points to a neurological basis for the disorder, suggesting that disruptions in the brain’s reward system may play a crucial role.
Dr. Salah El Mestikawy, a McGill Psychiatry professor and senior author of the study, along with his team, tested the effects of donepezil, a drug known to increase acetylcholine levels in the brain.
They found that donepezil completely reversed anorexia-like behaviors in mice. This promising result suggests that donepezil could be the first treatment targeting the neurological mechanism of anorexia.
Independent studies in Toronto and Montreal, led by psychiatrist Dr. Leora Pinhas, are already showing positive results in patients with severe anorexia nervosa.
Ten patients treated with low doses of donepezil have shown significant improvements, with three patients in full remission and seven showing marked improvement.
To confirm these findings, double-blind clinical trials are scheduled to take place this year at Columbia University, Denver University, and Hôpital Sainte-Anne in Paris. These trials will compare the effects of donepezil against a placebo to provide more robust data on its effectiveness.
Dr. El Mestikawy cautions that despite the promising results, it may take several years before donepezil or a similar drug is approved for widespread use in treating anorexia due to the need for extensive clinical trials and regulatory approval. Additionally, donepezil has several side effects, including gastrointestinal and muscular issues.
To address this, the McGill team is working with French researchers Stéphanie Daumas and Nicolas Pietrancosta to develop a new compound with fewer side effects.
The researchers also believe that donepezil might help treat other compulsive disorders, such as obsessive-compulsive disorder (OCD) and addictions. They are actively seeking collaborations with other psychiatrists worldwide to explore these possibilities.
This groundbreaking research not only offers hope for treating anorexia nervosa but also opens new avenues for understanding and managing other compulsive behaviors.
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