Can a Short-Acting Benzodiazepam Reduce Eating-Related Anxiety?

In a small trial, the agent had an effect, but not the one sought.

Since eating-related anxiety and reduced caloric intake are common among patients with anorexia nervosa (AN), wouldn’t use of a short-acting benzodiazepam such as alprazolam improve eating behavior among these patients? Apparently not, according to Dr. Joanna E. Steinglass and associates at Columbia University Medical Center and the New York State Psychiatric Institute (Int J Eat Disord. 2014; 47:901).

A randomized trial

The researchers sought to examine whether pre-meal anxiety contributes to restrictive eating in AN by experimentally manipulating the level of anxiety with alprazolam. To do so, they designed a randomized, double-blind placebo-controlled trial in 20 medically stable female inpatients with AN.

All participants received 0.75 mg of alprazolam on one test day, and a placebo the next. The order of medication administration was randomly assigned. The pills were encapsulated so they appeared to be identical and were dispensed by clinical staff members blinded to randomization assignment. The medication was administered 1.5 hour before the test meal. The two test days were planned within one week of each other, and participants ate a standard breakfast consistent with their caloric prescription. The test meal consisted of 975 gm of strawberry yogurt shake in a covered opaque 83-fluid-oz container with a straw.

Mean caloric intake and anxiety levels did not differ between alprazolam and the placebo. Dr. Steinglass and colleagues pondered the possibility that the measures of anxiety they had selected to test had in fact assessed a component of anxiety less sensitive to benzodiazepines. It also was possible, they suggested, that the severity and length of illness among this particular group of patients were associated with an entrenched meal-related anxiety and or with rules impervious to the effects of alprazolam. Perhaps the dosage was too low, but the chosen dose (0.75 mg) was a very reasonable one; furthermore, participants did report increased fatigue after receiving alprazolam, again suggesting that dosing may have been adequate. Finally, the study design used a test meal and single dose, which would be very different than the actual clinical implementation of benzodiazepine use in AN (in terms of both setting and dosing schedule). One might imagine that the feeding lab would be an ideal place to detect effects. However, the authors seem accurate in concluding that, while it is only a pilot study, the results are not at all encouraging regarding benzodiazepine use in patients with AN.