Medications and Eating Disorder Treatment

The central components of eating disorder treatment are meal planning and therapy, both individual and group. Medications play a peripheral role but can be important in certain circumstances.

Medications are most effective for comorbid psychiatric problems, especially when they are separate from the eating disorder. Treating depression and anxiety alleviates symptoms that typically exacerbates the eating symptoms and allows for more direct focus on recovery.

Seeing a psychiatrist knowledgeable enough to tease apart depression and anxiety secondary to the eating disorder, which typically respond less well to pharmacological intervention, and psychiatric symptoms separate from the eating disorder will help streamline overall progress in recovery.

Medications directed at the eating disorder symptoms have more mixed results.. The research into psychopharmacology for eating disorders is limited but gives a few important results dependent on diagnosis.

Despite the most rigorous research, no medication has proven to be effective for anorexia at this point. Many medications used in psychiatry, and some outside the purview of the field, have been studied to no avail. Even antidepressants tend to have no impact on people with anorexia who are depressed. The overall effect on the brain from starvation appears to trump all other interventions. The essential part of recovery is nutrition.

The most successful effect of medications is for bulimia and binge eating disorder. High dose SSRIs such as Prozac or Zoloft can be very effective for the sickest of these patients who binge at least twice daily almost every day of the week. Medications tend to reduce symptoms by about half after six weeks of treatment. Topamax, an anticonvulsant, also has benefit for people binging frequently but with less robust research results.

For the large number of patients with symptoms not easily categorized in one of the limited eating disorder diagnostic options, there is minimal evidence of benefit of medications. Treating underlying psychiatric problems can be beneficial, and attempting to use medications can have a moderate impact on progress, especially for adjunctive symptoms.

One last benefit of antidepressants is actually via a side effect. Most SSRIs can diminish the intensity of emotional reactions, a side effect called emotional flattening which often leads people to stop taking the drugs. For patients early in recovery who feel often unbearable emotional intensity, this side effect can be beneficial. The decreased intensity temporarily helps people stay on course with the food plan and tolerate the intensity of nourishing their mind. It is an often ignored but very useful pharmacological choice.

Psychiatric medications play a peripheral but often important role in recovery. Seeing a doctor versed in less common aspects of psychiatric care for eating disorders can be helpful to see alternative benefits of medications or to separate primary from secondary psychiatric symptoms related to the eating disorder. When the psychiatrist is integrated as part of a treatment team, the patient will always get the best results.