Serotonin in Human Eating Disorders DAVID C. JIM ERSON Department of Psychiatry Beth Israel Hospital Boston, Massachusetts 02215 and Harvard Medical School Boston, Massachusetts MICHAEL D. LESEM Harris County Psychiatric Center and Department of Psychiatry University of Texas Medical School Houston, Texas 77225 ARLENE P. HEGG Suicide and Suicidal Behavior Program Mood, Anxiety and Personality Disorders Research Branch National Institute of Mental Health Rockville, Maryland 20857 TIMOTHY D. BREWERTON Department of Psychiatry and Behavioral Sciences Medical University of South Caroli na Charleston, South Ca rolina 29425 INTRODUCfiON During the decade of the 1980s there has been increasing clinical and research focus on the eating disorders of anorexia nervosa and bulimia nervosa. Both syndromes are characterized by abnormal eating patterns coupled with psychological symptoms involving preoccupation with body sha pe and weight (TABLE 1). These eating disorder syndromes are estimated to affect two to five per cent of young women, the population at highest risk fo r these disorders, as well as a sma ller number of young men. 1 - 3 Anorexic patients often encounter serious medica l complications as a result of severe cachexia. Many patients with anorexia nervosa experience a prolonged course with recurrent relapse to low weight episodes, with poor long term outcome in approxi- mately one third of patients, and a mortality r ate as high as 18 per cent in long-t erm follow-up studies. 4 While antidepressants may diminish depressive and other psycholog- i ca l symptoms in anorex ic patients, 5 - 7 current pharmacological app roaches are of limited benefit as adjunctive treatment in weight restoration programs for low weight patients. The severity of symptoms in bulimia nervosa is apparent from test meal studies yielding estimates of mean caloric intake dur ing binge episodes ranging from 1500 to 4400 kcal. B- lo While short term outcome studies have demonstrated significant therapeutic benefit of pharmacotherapy and of psychotherapy for the majority of patients with bulimia nervosa, a substantial number of patients appear to have persistent symptomatology on follow-up.'' · 12 532