Eating Disorders and Medication
Dr Jonathan Haverkampf
Medication can be a valuable tool in the treatment of eating disorders. However, it is important that a treatment plan also include some form of psychotherapy and nutritional counseling. Medication alone will not likely be effective in treating an eating disorder.
Medication cannot cure an eating disorder. However, medications may help control urges to binge or purge or to manage excessive preoccupations with food and diet. Medications such as antidepressants and anti-anxiety medications may also help with symptoms of depression or anxiety, which are frequently associated with eating disorders.
The group of antidepressants called the selective serotonin reuptake inhibitors (SSRIs) have been used especially in cases of bulimia with some success. By inhibiting the reuptake of the neurotransmitter serotonin into the presynaptic cell, more is available in the synapse (the tiny gap between fibers from different nerve cells, or neurons). This leads to a downregulation of receptors for serotonin which changes the rate of information transmission from neuron to neuron and has been implicated in mood and anxiety disorders, for example. Frequently the older SSRI fluoxetine (Prozac®) is used in higher doses (60 or even 80 mg), which in clinical experience can help some patients greatly, and some not at all.
Every medication has potential side-effects and does not solve the psychological, social and other factors that have a considerable weight in eating disorders. Psychotherapy should always be an integral component in the treatment of eating disorders.
Anorexia
Antidepressants can even be counterproductive in anorexia, so caution is warranted. However, they may be needed to treat underlying mental health problems.
If SSRIs do not work, the antipsychotic olanzapine (Zyprexa®) may be a good option. It helps against obsessional thoughts (also in OCD) and one of its common side-effects is weight gain.
Bulimia
SSRIs, as already mentioned above, can work quite effectively in cases of bulimia. Fluoxetine (Prozac®) can help patients stop binging and purging when used alone or with CBT. At the time of writing, fluoxetine is the only antidepressant approved by the U.S. Food and Drug Administration (FDA) to treat bulimia. Other SSRI antidepressants may be helpful in treating bulimia and are often used, although scientific studies to support their use are limited.
Another possible bulimia medication is topiramate (Topamax®), a substance used to treat epilepsy. Topiramate may help people with bulimia suppress their urge to binge and reduce their preoccupation with eating and weight. However, because of its potential side-effects topiramate should not
Empirical evidence and clinical experience suggest that antidepressants in combination with psychotherapy can be effective in the treatment of bulimia. Clinical experience supports the use of most selective serotonin reuptake inhibitors (i.e., fluoxetine, sertraline and citalopram) as well as some of the newer antidepressants (i.e., venlafaxine).
Binge Eating
Standard treatment for binge eating and other eating disorders usually involves counseling and psychotherapy. Some doctors also prescribe antidepressants to try and curb eating disorders, though they are not approved for that use. Antidepressants can help treat binge eating disorder. SSRIs, such as Fluoxetine (Prozac®) and Sertraline (Zoloft®), may help reduce binge eating and can improve mood in patients who are also struggling with depression or anxiety. However, many SSRIs lead to weight gain rather than weight loss. A serotonin and norepinephrine reuptake inhibitors (SNRI) like Venlafaxine may help with weight loss, but there is little systematic clinical experience on its usefulness against binge eating.
Topiramate has also been used to treat binge eating disorder with sporadic anecdotal success.
The stimulant vyvanse (lisdexamfetamine dimesylate, which is also used to treat ADHD, has been approved by the FDA in the treatment of binge eating disorder. It is not approved to treat obesity, however.
© Dr Christian Jonathan Haverkampf. All rights reserved.
Psychotherapy & Counselling, Communication, Medicine (Psychiatry); Dublin, Ireland
For psychotherapy, counselling and communication coaching visit www.jonathanhaverkampf.com, www.jonathan-haverkampf.com, www.wordnets.com and www.jonathanhaverkampf.ie.
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