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• Patients with anorexia nervosa have concurrent problems of emaciation and depression. Therefore, treatment with medications affecting both weight gain and depression seemed reasonable. Seventy-two anorectic patients were randomly assigned in a double-blind study to receive cyproheptadine hydrochloride, a weight-inducing drug, amitriptyline hydrochloride, a tricyclic antidepressant, or placebo. Overall, cyproheptadine had a marginal effect on decreasing the number of days necessary to achieve a normal weight. There was a differential drug effect present in the bulimic subgroups of the anorectic patients: cyproheptadine significantly increased treatment efficiency for the nonbulimic patients and significantly impaired treatment efficiency for the bulimic patients when compared with the amitriptyline- and placebo-treated groups. The differential cyproheptadine effect on the anorectic bulimic subgroups is the first pharmacologic evidence of the validity of these subgroups. Cyproheptadine had an antidepressant effect demonstrated by a significant decrease in the Hamilton depression ratings.

• Twenty-four-hour measurements of wrist and ankle kinetic energy expenditures were obtained on 20 hospitalized female anorectics during the first two weeks of their hospitalization. Kinetic energy was examined against measures of weight, depression, and Minnesota Multiphasic Personality Inventory scores in a regression analysis. Effect of cyproheptadine hydrochloride, amitriptyline hydrochloride, and placebo on activity was assessed. The results supported previous studies showing a positive relationship between weight gain and motor activity and challenge the commonly held notion that activity decreases in anorectics as their clinical condition improves. Motor activity was initially significantly suppressed by cyproheptadine and subsequently increased.

To the Editor.— In an earlier publication 1 we reported the effects of cyproheptadine hydrochloride on weight gain in 81 anorexia nervosa patients. Cyproheptadine is a serotonin and histamine antagonist with anticholinergic and sedative effects. Since that time, we have completed the full sample of 105 patients and have found that cyproheptadine affects characteristics of anorexia nervosa other than body weight. Females aged 10 to 40 years who met our study criteria for anorexia nervosa (an adaptation of those of Feighner et al 2 ) were entered into a pretreatment period of seven days in hospital, after which they were randomly allocated to groups receiving combinations of (1) cyproheptadine or placebo, and (2) behavior modification or its absence, and followed up on these treatments in the hospital for 35 days. Aside from body weight, patients were evaluated periodically on a variety of symptoms, behaviors, and attitudes. This design was repeated in