Table of ContentsView AllTable of ContentsAnorexia NervosaBulimia NervosaBinge Eating DisorderWarning About Wellbutrin
Table of ContentsView All
View All
Table of Contents
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Warning About Wellbutrin
Recovery from an eating disorder is challenging. If you or a loved one has an eating disorder, you may be wondering: Can medication help? The answer is complicated.
For eating disorders, food (and the normalization of eating patterns) is the primary medicine. This is combined with therapy to help distorted thoughts (or unhelpful thoughts) surrounding food, weight, eating, andbody image.
In some cases, psychiatric medication (such as antidepressants, antipsychotics, or mood stabilizers) can make therapy more successful.Many people with eating disorders also struggle withanxietyanddepressionand medication may help with those symptoms.
A thoroughdiagnostic evaluationwith apsychiatristis always recommended before beginning any regimen of psychiatric medication. Among other things, it is essential to determine whether anxiety and mood symptoms came before the eating disorder or could be symptoms of malnutrition.
Medication should generally not be the initial or primary treatment foranorexia nervosa. While some success has been shown with pharmacological treatment for bulimia and binge eating disorder, there is far more evidence supporting nutritional rehabilitation andpsychotherapyfor treating anorexia nervosa, compared with medication.
No medication has yet been FDA approved for the treatment of anorexia.
Typically, when medication is prescribed, the primary goal tends to be weight gain or to treat the anxiety or depressive symptoms that may co-occur with the anorexia. It is often prescribed for patients who have under-responded to nutritional restoration and psychotherapy.
However, even in these cases, the efficacy of medication has not been well studied—treatment trials are considered challenging to conduct on patients with anorexia because these patients tend to be reluctant to take medication for fear of weight gain.
Antipsychotics for Anorexia
Interestingly, even though patients with anorexia often have significantly distorted views of food and their bodies that are similar to psychotic delusions, these symptoms do not appear to respond to antipsychotic medications.
If antipsychotics are used, they are recommended to be used in conjunction with behavioral interventions that aim to help the patient achieve and maintain a healthy weight.
Antidepressants for Anorexia
Antidepressant medications typically do not help with weight gain, although they can be used to treat co-occurring anxiety and depression.Unfortunately, many medications donotseem to work well in patients with anorexia nervosa. This may be becausestarvation affects the function of neurotransmittersin the brain.
Benzodiazepines for Anorexia
Sometimes, benzodiazepines may be prescribed for use before meals to reduce anxiety. However, no research supports this practice, and benzodiazepines can become addictive.
Benzodiazepines can lead to dependence and addiction even when taken as prescribed. People also experience potentially dangerous withdrawal symptoms when discontinuing benzodiazepines. If you are taking these medications, it is not safe to stop taking them on your own. Always talk to your doctor first about gradually tapering your medication under their supervision.
Oral Contraceptives for Anorexia
Research reminds us that low bone density is best treated with weight restoration, which is, at this time, the only known way to normalize the hormones that contribute to bone weakening.
Psychiatric medications have been shown to be helpful for the treatment ofbulimia nervosaand are most often used in addition to nutritional rehabilitation and psychotherapy.Nutritional restoration is focused on establishingregular and structured meals.
Medication alone is not usually recommended for bulimia nervosa unless a patient does not have access to psychotherapy and nutrition therapy.
SSRIs for Bulimia
It is not yet known exactly why they work; however, it is hypothesized that in at least some patients the serotonin pathways in the brain are disturbed. This class of antidepressants has been shown to reduce binge eating, purging, and psychological symptoms such as the drive for thinness. This class of medications has demonstrated helpfulness in improving co-occurring symptoms of anxiety and depression.
Treatment studies show that SSRIs are most effective when combined with psychotherapy.Medication may make psychotherapy more effective for some. Medication alone is not as effective for most patients as psychotherapy alone. Medication may also be effective when combined withself-help and guided self-help approaches.
Off-Label Use
Research shows that if a patient with bulimia nervosa responds well to Prozac, they will likely show a positive response within three weeks of taking the medication. It is important to note that multiple randomized control trials have established 60 mg of Prozac as the standard dose for bulimia nervosa.This is higher than the standard dose used for major depression (40 mg).
If Prozac does not work, other SSRIs are often tried next. It is not uncommon for other agents, such as the anticonvulsanttopiramate, to be used off-label for bulimia. It is generally recommended that patients stay on medication for 6 to 12 months after achieving improvement on the medication.
Medications seem effective in helping patients withbinge eating disorder (BED)stop the binge eating episodes but do not generally produce the weight loss that is a common goal for patients seeking help for this disorder.
For BED, three main classes of medications have been studied: antidepressants (primarily the SSRIs, including Prozac); antiseizure medications, especially Topamax (topiramate); and Vyvanse (lisdexamfetamine).
Antidepressants for BED
As they do for patients with bulimia nervosa, antidepressants can help reduce the frequency of binge eating in patients with BED.They can also help to reduce obsessive thoughts and symptoms of depression. Topiramate can also help reduce the frequency of binges and may also reduce obsessive thoughts and impulsivity.
Stimulants for BED
Stimulant medications used in treating attention deficit hyperactivity disorder (ADHD) are noted to suppress appetite and so have been a recent focus of attention for treating BED.
There have been insufficient studies directly comparingmedication treatmentto psychological treatment for BED, but medications are generally considered less effective than psychotherapy. Thus, they should usually be considered a second-line treatment after psychotherapy, as an adjunct to psychotherapy, or when therapy is inaccessible.
The antidepressant bupropion (often marketed as Wellbutrin) is often prescribed to patients who are trying to lose weight and who may also exhibit depressive symptoms. Wellbutrin has been associated with seizures in patients with purging bulimia, however, and is not recommended for patients with eating disorders.
Summary
In general, medication is not typically the primary mode of treatment for an eating disorder. Medication may be helpful when added to psychotherapy or when psychotherapy is not available. Further, medication is often used when patients also have symptoms of anxiety and depression to help with these symptoms.
However, medications can carry a risk for side effects that are not found with psychological therapies. Ultimately, the “medication” of choice for an eating disorder is food and normal eating as well as finding a way to cope with the unhelpful or distorted thoughts surrounding food, eating, and body image.
There are varioustreatments for eating disordersthat are considered efficacious, includingcognitive behavioral therapyandfamily-based treatment.
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8 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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