Understanding Medications in Eating Disorders

Medications and Anorexia Nervosa

Recent systematic reviews of RCTs and meta-analyses of the pharmacological treatment of AN suggest weak evidence for the use of any psychotropic agents with no evidence that the selective serotonin re-uptake inhibitors (SSRIs) treat the core feature of AN or prevent relapse. Low doses of antipsychotics such as olanzapine or quetiapine may be helpful when patients are severely anxious and demonstrate obsessive eating-related ruminations, but more trials are needed Caution is required for any psychotropic medication, as physical problems secondary to anorexia nervosa may place individuals at greater risk of adverse side effects.

In the acute stages of AN, comorbid conditions such as anxiety, depression or obsessive-compulsive features may resolve with weight gain alone without the need for consideration of medication.

SSRIs may be beneficial in the treatment of comorbid anxiety disorders, depression and obsessive-compulsive disorder in the non-acute stage of AN.

Medications and Bulimia Nervosa & Binge Eating Disorder

Selective serotonin re-uptake inhibitors (SSRIs) in combination with psychotherapy (such as CBT) has been shown to have the best outcome in the management of BN, though SSRIs on their own have been shown to reduce binge eating episodes and purging. The majority of trials have been conducted with Fluoxetine. While pharmacotherapy may be effective in treating target symptoms of bingeing and purging, few patients achieve remission with pharmacotherapy alone. Pharmacotherapy as a adjunct treatment can be considered as additive benefit has been shower for combined psychological and pharmcological therapy.