Eating disorders, or ED, are complex psychiatric illnesses characterized by abnormal eating behaviors and an intense preoccupation with food, body weight, and shape. This can lead to various complications, affecting cognitive, emotional, and social functioning.
Unlike many other conditions, ED do not respond as effectively to a wide range of pharmacological treatments to alleviate specific symptoms. Research suggests that specialized psychotherapies are more successful in reducing ED symptoms, particularly in children and adolescents, and are often recommended as the initial treatment option in major guidelines.
Recent evidence highlights the importance of medication adherence in the effective treatment of anorexia nervosa (AN). Constantly changing medications may not help promote weight gain and could disrupt the rapport with patients suffering from AN. Pharmacotherapy, especially the use of antidepressants, has shown to be more effective than having no treatment at all. However, further research is required to confirm these findings.
Selective serotonin re-uptake inhibitors (SSRIs) have been a focus in treating eating disorders. Current data supports their effectiveness, especially in individuals who are nutritionally restored or exhibit bulimic behaviors. However, in cases of malnutrition, SSRIs may not have the desired robust effects due to decreased amino acid intake associated with lower caloric consumption. The efficacy of SSRIs could be compromised due to reduced neurotransmitter production related to amino acids necessary for serotonin synthesis. Despite this, given their generally safe profile and relative ease of discontinuation depending on the specific SSRI utilized, these medications are often considered as a starting point if psychotropic medication is desired by the individual.
Attention deficit hyperactivity disorder (ADHD) commonly co-occurs with eating disorders and can hinder recovery. Stimulant medications, the gold standard for treating ADHD, can be beneficial by addressing symptoms like hyperfocus on body image, weight, and food without decreasing appetite when used cautiously under the supervision of qualified professionals.
Bupropion: There is a common misconception that certain medications, such as bupropion may be inappropriate for those with eating disorders, particularly individuals engaging in bulimic behaviors. Check out my blog on this topic for more insight, https://www.docdusty.com/post/bupropion-how-dangerous-is-it-in-ed-treatment.
Antipsychotic Medications: Research has shown small, inconsistent weight gain with antipsychotic medications, but the clinical significance of this weight change is debatable. It's important to consider whether the weight gain is truly driven by psychological improvement or merely a side effect of the medication. Due to the potential interference of these medications with treatments like Eye Movement Desensitization and Reprocessing (EMDR), caution is advised in their prescription (especially in my opinion!). Learn more about EMDR-Eating Disorders https://www.docdusty.com/post/rethinking-treatment-approaches-emdr-for-eating-disorders . Antipsychotics may interact with other psychiatric medications and medications commonly prescribed for gastrointestinal concerns related to eating disorders so please keep this on your radar.
Further research with larger sample sizes and longer follow-up periods is needed to understand the role of psychotropic medications in managing eating disorders. Currently, there are no medications approved for the treatment of anorexia nervosa in adults or children and adolescents. Treatment literature suggests the use of medications like fluoxetine and lisdexamfetamine for bulimia nervosa and binge eating disorder in adults, but caution is observed in prescribing medications to avoid disempowering messages and fostering dependency. The focus should lie in addressing the underlying causes of mental health issues and eating disorder behaviors, whether utilizing medications alongside therapy or opting for non-pharmacological interventions depending on each individual's needs.
References:
Solomon CG, MitchellPeterson JECB. Anorexia nervosa. N Engl J Med. 2020;382:1343–51.
Chiu, HP., Huang, MW., Tsai, SY. et al. A retrospective study of pharmacological treatment in anorexia nervosa: 6-month and 12-month follow-up. BMC Psychiatry 23, 126 (2023).
Costandache GI, Munteanu O, Salaru A, Oroian B, Cozmin M. An overview of the treatment of eating disorders in adults and adolescents: pharmacology and psychotherapy. Postep Psychiatr Neurol. 2023 Mar;32(1):40-48.
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