Eating Disorder Medications

Can Medication Treat Eating Disorders?

Medication for eating disorders can be useful when combined with psychotherapy. Eating disorder medication is used to treat co-occurring disorders such as depression and anxiety. Antidepressants are often the most common medication prescribed to help manage some of the behaviors found in eating disorders such as binge eating and purging behaviors.³

Eating disorders are manifested by dysfunctional eating-related behaviors that create altered or impaired adequate nutritional intake and cause significant impact on one’s physical and mental health.²

For effective treatment results the multidisciplinary team will often discuss the clients’ progress together to see what areas need to be worked on or if anything needs to be changed as far as medication management or coping skills found in therapy.

Medications for Anorexia Nervosa

Evidence-based research has found that most psychotropics have not been effective on individuals with anorexia nervosa. Medication for anorexia has been found to be most effective when combined with psychotherapy. Clinicians may prescribe medications for individuals with anorexia nervosa for their co-occurring disorders that can often accompany an eating disorder, such as depression, anxiety, and or obsessive-compulsive disorder.⁴

Anorexia nervosa is an eating disorder that is considered to be a severe psychiatric disorder due to the medical complications that it can create including even death. Individuals with anorexia nervosa will often restrict their food intake to dangerous levels.They can often be treatment resistant as they do not see the gravity of the situation and struggle with anxiety in regards to weight gain and body appearance.⁴

Some medications prescribed for conditions commonly comorbid with anorexia nervosa include:

Antidepressants

Antidepressants include a wide variety of medications to treat various symptoms of depressive disorders. However, they have an off-label use and can also be prescribed in anxiety, sleep disorders, eating disorders, and substance abuse recovery.⁵ The anti depression medication alone cannot be the only thing to treat anorexia nervosa or there will be no efficacy in treating the disorder itself.⁴ It must be combined with psychotherapy.

With all medications, there will sometimes be side effects that come along with it such as nausea, sleep issues, possible weight gain,fatigue, anxiety, constipation, drowsy mouth, or sexual side effects.⁶

Antipsychotics

Antipsychotics are a large group of medications used to treat psychosis and are classified as either atypical or typical(first versus second generation).⁵ Clinicians might prescribe them to individuals with anorexia nervosa to help stimulate appetite and help increase weight gain.⁴ This sometimes presents a challenge as many patients with anorexia will decline to take the medication as they do not want to gain weight.

Side effects commonly experienced with antipsychotics can vary in intensity and include sedation, dry mouth, constipation, sexual side effects,weight gain and or ones that impact medical health such as tardive dyskinesia and akathisia.⁷

Mood Stabilizers

Mood stabilizers are used to treat and stabilize the mood shifts associated with bipolar disorder, schizoaffective disorder, or at times borderline personality disorder.⁵ For individuals with anorexia, clinicians might prescribe mood stabilizers to hopefully increase appetite and help regulate any co-occurring disorders.

Common side effects include weight gain, skin rash, and gastrointestinal complaints.⁸

Medications for Bulimia Nervosa

Medications for bulimia nervosa, a severe and potentially deadly psychiatric disorder, can be effective when combined with counseling. Medications that have been successful in the treatment of bulimia include Selective Serotonin Reuptake Inhibitors (SSRIs), which may reduce the binge-purge cycle and improve depression.

It is not sufficient to have medications as a treatment alone and should be followed with proper counseling, and dietary counseling in order to address the complexities of bulimia. In terms of medications, it is important to speak with a healthcare prescribing provider in order to decide what is best for the individual.

Some medications used to treat bulimia nervosa include*:

Antidepressants

Antidepressants can serve many functions when treating the complexities of eating disorders. Antidepressants in bulimia have been useful in decreasing binge-eating and purging behaviors.³

Fluoxetine, an SSRI, has shown evidence of successfully treating individuals with bulimia¹ and is FDA approved for this indication.

Anticonvulsants/ Anticraving

Another medication that is mainly used to treat seizures and at times for mood stabilization, Topiramate, has been used for bulimia. Studies found that Topiramate helps reduce binging and purging episodes.¹

Medications for Binge-Eating Disorder

Medications for binge-eating disorder, a severe psychiatric disorder, have had more success in efficacy than when used in other eating disorders. There have been studies showing that Selective Serotonin Reuptake Inhibitors (SSRIs), such as fluoxetine, decrease binge episodes. This is also true to the binge episodes occurring in bulimia. Another successful medication is the ADHD treatment, lisdexamfetamine (Vyvanse), which has shown promising results in the treatment of BED.¹

However, medication management is not sufficient for adequate treatment of BED and psychotherapy is necessary for effective therapeutic levels. A trained prescribing provider can determine the best medication for the individual. Therapeutic interventions can help the client address the psychological role of the eating disorder.

Some medications used to treat binge-eating disorder*:

SSRIs

SSRIs can help reduce the symptoms of depression and anxiety that co-occur with BED. As well as reduce episodes of binge eating.³

Stimulant Medications

While usually prescribed in the treatment of ADHD, stimulant medications like lisdexamfetamine is the main medication being used for BED. Studies have shown to increase satiety in individuals and reduce food intake, and results are promising.⁹

Anticonvulsant

Topiramate, an anticonvulsant, can also serve as a way to decrease food cravings and reduce binge episodes.¹

*Please be aware that Antidepressant medications have a risk of side effects, including serious side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.

Potential Side Effects of Eating Disorder Medications

It is important to familiarize yourself with common side effects associated with medications used for eating disorders. Additionally, if you have any questions about managing or monitoring your medication, always consult with the prescribing healthcare professional. Side effects can range from mild to more concerning.

Side effects of eating disorder medications can include:⁶

• Appetite changes
• Nausea
• Sleep impacts
• Fatigue
• Dry mouth
• Gastrointestinal issues

It’s important to speak to your medical provider before stopping the medication if you do experience side effects.Many times these side effects will subside so it is important to be fully educated on the medications.

Medication as Part of a Multidisciplinary Approach

In eating disorder treatment, medications are only one part of the journey. Even so, medications for eating disorders can play a pivotal role in the reduction of certain symptoms and assist in the individual’s co-occurring disorders. It is necessary to combine medication with other aspects of treatment such as psychotherapy, dietitian services, physician, psychiatrist, and group counseling – all with the speciality of eating disorder training.

The combination of treatments help address the different complex issues that eating disorders can bring. It is easier to develop a more personalized treatment plan in eating disorder care with a multidisciplinary treatment team as the providers can work together in synergy and share with one another their concerns.

Challenges in Eating Disorder Medication Management

Managing medication in eating disorders comes with certain challenges.These include, adherence issues, the need of regular medical monitoring, and finding a skilled clinician that can find the right medication. However, it is important to make sure that you address any barriers or concerns of proper treatment.

Adherence is necessary to see if the medication is helping reduce symptoms. That way the psychiatrist knows whether the medication is effective. Regular medical monitoring is important to make sure the client’s overall health and well-being are not in jeopardy. In eating disorder treatment both physical and psychological health are impacted. Therefore, it is important for individuals to be closely monitored by a medical prescribing provider skilled in eating disorders and medication management.

Therapeutic Treatment Options for Eating Disorders

Understanding that medication for eating disorders works best when combined with therapy is the first step for a successful recovery. Medication can help treat the physical symptoms within the body while psychotherapy can help address the psychological aspect of the eating disorder.  When both work together they serve as a way to enhance recovery and treatment. It is reassuring to know that several options for eating disorder treatment are available to assist.

Treatment options for eating disorders include:

• Enhanced cognitive behavior therapy (CBT-E): Enhanced cognitive behavior therapy CBT-E works on disordered thought patterns that contribute to disordered eating. Treatment will involve one on one care to address the ideals that contributed to a person’s attitudes and beliefs on weight and body shame.¹⁰
• Online eating disorder treatment programs:  For individuals who are not able to access in-person eating disorder treatment programs there are other options such as online programs like Equip Health and Within Health that can provide treatment from the convenience of home.
• Group therapy:  Eating disorder professionals might suggest group therapy for eating disorders.  Group therapy helps provide a safe space and helps prevent the feelings of isolation while recovering from an eating disorder.
• Eating Disorder Trained Coach: There are coaches who have received extra training and certificates in how to work with individuals with eating disorders. These individuals can help assist patients transitioning from higher levels of care to more of an outpatient setting.

How to Find Treatment for Eating Disorders

Finding and gathering a support team to help in the process is key to future success and relief from an eating disorder. Finding a therapist from an online directory that specializes in eating disorders can be beneficial, as well as finding a psychiatrist to help with medication management if necessary. Eating disorder informed clinicians can also provide guidance in helping individuals find dietitians that also specialize in eating disorders to help with the recovery process.

Realizing the need for help is the first big step towards recovery and it shows strength. Knowing that it is time to help find treatment is the beginning of the journey. Together with the treatment team a person can develop support that can help guide the person through the necessary steps to protect their health and mental well-being.

The Future of Medication Treatment for Eating Disorders

The future of medications to treat eating disorders continues with ongoing research and studies to test out efficacy. Even though it takes time to see the results, it is exciting to see all the new possibilities for the future that exist to assist individuals recovering from eating disorders.  Alternative and experimental therapies for the most treatment resistant eating disorders include neuromodulation techniques, such as repetitive TMS, which helps stimulate neural activity in the brain by using a non-invasive procedure of magnets being placed on one’s head.¹

Many researchers report that more studies are needed in the area of ED treatment; therefore, many medications are still being tested for effectiveness. A new one that looks to have a bright future is Ketamine. Ketamine might offer success to the most treatment resistant individuals with years of psychotherapy treatment, nutritional counseling, and who have had other pharmacological interventions.⁹