Pharmacotherapy in Eating Disorders Treatment

Rounding out our discussion of a multidisciplinary approach to eating disorders treatment (at least for now), it is important to spend some time talking about the use of medication with eating disorders patients. Today, I'll spend a few moments on the subject of pharmacotherapy for the treatment of bulimia nervosa and binge eating, and follow this with a discussion on the use medication with anorexia patients in my next post.

There has been a great deal of research in recent years investigating the role of medication in the treatment of bulimia nervosa and binge eating. While psychotherapy (particularly cognitive-behavioral therapy) has been shown to be effective for reducing binge eating and purge behaviors, a combination of pharmacotherapy and psychotherapy has, in some studies, demonstrated additional benefit; thus suggesting that psychotherapy in conjunction with pharmacotherapy may yield a greater benefit than either intervention alone (Mickley, 2004). Studies show that for many patients, certain medications may reduce the occurrence of binge/purge symptoms, as well as alleviate associated mood and anxiety symptoms.

Some of the medications that have been shown to be beneficial for reducing binge/purge behaviors associated with bulimia nervosa and bing eating disorder are:

• Tricyclic antidepressants (TCAs)
• Selective Serotonin Re-uptake Inhibitor (SSRIs) antidepressants
• Serotonin-Norepinephrine Re-uptake Inhibitors (SNRIs) (e.g., venlafaxine)
• Monoamine Oxidase Inhibitors (MAOIs)
• The anticonvulsant medication Topiramate

Multiple studies have yielded the effective treatment of bulimia nervosa with SSRIs. In fact, the SSRI Fluoxetine has been approved by the U.S. FDA for the treatment of bulimia nervosa. Benefit is derived from these SSRI pharmacotherapy even in the absence of co-occurring symptoms of depression. Studies show that SSRI treatment of bulimia nervosa has a significant short term benefit in reducing symptoms, however long term relapse rates are also high. In addition, it appears that the efficacy of pharmacotherapy for binge/purge symptoms does not differ substantially between classes of  antidepressants (Mitchell, et.al., 2007), however, SSRIs may be better tolerated by some patients.

Another agent frequently used in the treatment of depression and other conditions, bupropion, yielded some benefit for bulimia nervosa in scientific investigation, however, multiple participants in this investigation experienced grand mal seizures, leading to the conclusion that bupropion is contraindicated for eating disorders patients.

The anticonvulsant Topiramate has demonstrated effectiveness both in reducing binge/purge symptoms, as well as for weight loss, thus it may be a medication for consideration with binge eating disorder patients. Other medications that may be useful for BED and obesity treatment are sibutramine, which has been shown to yield moderate to substantial weight loss in some patients, and orlistat, which has yielded weight loss and has been shown to also reduce eating disorder symptoms to a moderate degree.

While pharmacotherapy is given strong consideration in the treatment of eating disorders, cautionary reports for the use of certain agents when treating children and adolescents should also be considered.

Sources:

Mickley, D. (2004). Medication for anorexia nervosa and bulimia nervosa. Eating Disorders Today, 2(4), 1 & 15.

Mitchell, J. E., Steffen, K. J., & Roerig, J. L. (2007). Management of Bulimia Nervosa. In Yager, J. & Powers, P.S. (Eds.) Clinical manual of eating disorders, pp.171-193. Washington D.C.: Amercian Psychiatric Publishing.   

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There was also a recent study out demonstrating the effectiveness of olanzapine (Zyprexa) in treating anorexia, leading to an increase in weight and a decrease in obsessive thoughts and behaviors.

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