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Treating Eating Disorders with Medication
Many mental health disorders can be treated using pharmacological medications. Eating disorders have been challenging in this respect as, for quite some time, medications have been available to support the mood symptoms related to eating disorder behaviors but not the behaviors themselves.
While treating co-occurring mental health disorders continues to be helpful in eating disorder treatment, researchers are also continuing to search for medications that can treat the eating disorder behaviors themselves.
Co-Occurring Disorders and Medications
One of the most common ways in which medication is helpful in treating eating disorders is by treating comorbid disorders and symptoms. Many individuals use eating disorder behaviors to cope with symptoms of depression, anxiety, trauma, and more. Utilizing medication to reduce the occurrence of these symptoms can, subsequently, help reduce the eating disorder behaviors that were used to cope with the symptoms.
Anorexia Nervosa is an eating disorder marked by severe restriction of nutritional intake that is often coupled with a desire to alter the body in some way. Individuals with anorexia nervosa might strive for a specific body appearance or might use restrictive behaviors to disconnect from their body or cope with emotional dysregulation or feelings of instability.
There is still no medication found that can treat the choices of restriction alone. Due to this, the American Psychological Association specifies that “psychotropic medications should not be used as the sole or primary treatment for anorexia nervosa, but they can be considered for the prevention of relapse in weight restored patients or to treat depression or obsessive compulsive disorder .” The FDA has also not currently approved any medication solely for treatment of anorexia behaviors.
Medication prescribed to those with anorexia nervosa often serves the function of reducing other mental health symptoms or providing support in weight gain. Research has found “limited evidence that antidepressants may help maintain weight gain in successfully treated patients” and that “anxiolytic medications may be helpful before meals for the anorexic patient who is having anxiety before eating .”
Learn more about medications and anorexia
Olanzapine Treatment for Patients with Anorexia Nervosa
Olanzapine is considered to be an “atypical antipsychotic” medication and is often used to treat symptoms of psychosis. Compared to “typical” or “first generation” antipsychotics, “atypical antipsychotics” cause less negative motor control and coordination side effects. Olanzapine is the drug name but might be referred to by brand names such as Zyprexa.
For treatment of anorexia nervosa, Olanzapine has been effective in “reducing psychological distress particularly in the re-feeding phase of anorexia nervosa treatment .” One study found that “those taking olanzapine showed a greater rate of increase in weight (achieving target BMI earlier) and improvement of obsessive symptoms .” Additionally, those taking Olanzapine have been observed experiencing “improved weight restoration, decreased levels of anxiety, and ruminating thoughts involving food and body image .” It is worth noting that many of these studies involved more acute cases of anorexia nervosa, therefore, Olanzapine might be most effective when all other treatments have not improved symptoms.
The mechanism by which Olanzapine successfully supports anorexia treatment is not fully understood at this time. Some theorize that it supports the reduction of rigid thought processes that contribute to anorexia behaviors. Further, Olanzapine helps in stimulating appetite and facilitating weight gain which supports the refeeding process of treatment.
- Treating Binge Eating Disorder
- Seeking Treatment for Anorexia
- Bulimia Nervosa Treatment
- Antidepressants for Co-Occurring Anxiety & Eating Disorders
Medication for Binge Eating Disorder
Binge Eating Disorder (BED) involves individuals engaging in binge episodes wherein they consume large amounts of food in short periods of time, often feel a loss of control in these moments, and experience shame and guilt afterward. There are a few medications that effectively support BED recovery.
Antidepressants such as “tricyclics, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs), and several atypical agents (mianserine, trazodone, and bupropion) have all been shown to be superior to placebo for reducing the frequency” of binge eating . These medications are likely helpful due to their treatment of comorbid symptoms. Additionally, “BED may be associated with abnormalities in serotonin, norepinephrine, and dopamine which are targeted by most antidepressant classes .”
While not currently approved by the FDA, anti-obesity agents are also being researched as possible treatments for BED as they “may have anti-binge eating properties, either directly through appetite suppressant or satiety-enhancing properties or indirectly through metabolic effects .”
Lisdexamfetamine / Vyvanse for Binge Eating Disorder
Lisdexamfetamine is utilized to treat Attention-Deficit Hyperactivity Disorder (ADHD). These have been considered in the treatment of BED for a few reasons. First, “most drugs used to treat attention deficit hyperactivity disorder facilitate function of the dopamine and/or norepinephrine systems, which are involved in eating behavior and reward as well as in the biology of binge eating .” Additionally, “epidemiological data have indicated a relationship between BED and attention deficit hyperactivity disorder in both adolescents and adults,” therefore, treating one may support in treating the other .
Lisdexamfetamine is the “first pharmacologic agent to be approved by the US Food and Drug Administration for the treatment of moderate or severe BED in adults .”
Topiramate / Topamax for Binge Eating Disorder
Topiramate is an anti-seizure medication that has been considered to treat BED. Topiramate has been found to be “significantly superior to placebo in reducing binge frequency, as well as obsessive-compulsive features of binge eating symptoms .” Further, one study found that “topiramate-treated patients experienced a 94% reduction in binge frequency…whereas placebo-treated patients experienced a 46% reduction in binge frequency .”
Even so, the research indicates that the negative side effects of Topiramate such as “paresthesias, dry mouth, headache, and dyspepsia” led to a high dropout rate .
Bulimia Nervosa is an eating disorder characterized by episodes of binge eating (as mentioned above in BED) followed by compensatory behaviors such as purging or exercise to rid the body of calories consumed during the binge. There are numerous medications that have proven to be effective in supporting bulimia recovery such as:
- “Tricyclic antidepressants, such as desipramine (Norpramin®, Aventis), imipramine (Tofranil®, Ciba Geigy), and amitriptyline (Elavil®, Merck & Co.).
- Monoamine oxidase inhibitors were also found to be more effective than placebo in decreasing the binging and vomiting in patients with bulimia nervosa.
- Buspirone (Buspar®, Bristol Myers Squibb) was also effective in decreasing binging and vomiting in patients with bulimia nervosa .”
It is worth noting that lithium has not proven effective in the treatment of bulimia nervosa. Further, the above-mentioned Topiramate shows effectiveness in treating bulimia nervosa, however, more research is needed.
How Does Prozac Help Bulimia Nervosa Treatment?
The most common medication considered for the treatment of bulimia nervosa is fluoxetine, often referred to by the brand name Prozac. This is the only medication approved by the FDA to treat adult bulimia nervosa. Fluoxetine is an SSRI and likely supports bulimia recovery due to the impact it has on the serotonin system, which influences aspects such as hunger and fullness.
As far as effectiveness, fluoxetine is a promising pharmacological option for treating bulimia, as “treatment with the lower dose of fluoxetine resulted in reductions in binge eating and vomiting compared with placebo .” One study found that “those receiving 60mg of fluoxetine had even greater improvement with a 67-percent reduction in binge eating and a 56-percent reduction in vomiting .”
Eating Disorder Recovery: Medication-Assisted Treatment Pros and Cons
Whether treating eating disorders or other mental health disorders, there are pros and cons to utilizing pharmacological medications.
The cons of using medication to support eating disorder treatment can be subjective. Many medications have the potential side effect of weight gain. Some, but not all, individuals in eating disorder treatment might need to weight restore, making this a helpful side effect. Even so, the emotional impact of weight restoration, wetherby medication side effects or refeeding, can be challenging for the individual emotionally as part of their motivation for disordered eating behaviors may have been to lose weight or achieve a specific body appearance.
An additional con of pharmacological interventions for eating disorders is the uncertainty. With any medication regimen, it takes time to learn how each individual will respond to a medication, whether it will be helpful, and whether the individual experiences any negative side effects as worth the benefits. The time it takes to experience the impact of medication can be challenging, particularly if the medication is not helpful and the individual has to go through the “medicine dance” of trying numerous medications until they find one that is helpful to them.
The pros of using medication to support eating disorder treatment and recovery are that it can provide a reduction of other comorbid mental health symptoms and lead to overall mood and daily life improvement. This allows an individual struggling to not only reduce eating disorder behaviors but to experience a more fulfilling daily life.
With any of the medications mentioned above, it is crucial to consult with a Psychiatrist before taking any or becoming attached to the idea of any medication “saving” you. There is no current medication approved as a stand-alone treatment for eating disorders, therefore, engaging in a multi-disciplinary treatment that includes therapy and nutritional support is also crucial for recovery. If you would like to consider pharmacological interventions for your eating disorder, empower yourself to ask questions of your doctor or psychiatrist.
Citations Gorla, K., Matthews, M. (2005). Pharmacological treatment of eating disorders. Psychiatry, 2:6.  Hay, P. J., Claudino, A. M. (2012). Clinical psychopharmacology of eating disorders: a research update. International Journal of Neuropsychopharmacology, 5.  Norris, M. L., et al. (2011). Olanzapine use for adjunctive treatment of adolescents with anorexia nervosa. Journal of Child and Adolescent Psychopharmacology, 21:3.  McElroy, S. L., et al. (2012). Pharmacological management of binge eating disorder: current and emerging treatment options. Therapeutics and Clinical Risk Management, 8.  Guerdjikova, A. I., et al. (2016). Novel pharmacologic treatment in acute binge eating disorder: role of lisdexamfetamine. Neuropsychiatric Disease and Treatment, 12.
Author: Margot Rittenhouse, MS, LPC, NCC
Page Last Reviewed and Updated By: Jacquelyn Ekern, MS, LPC 3.1.2022