Antipsychotic Medication in Treating in Treating Disorders

In residential treatment centers patients with eating disorders are increasingly prescribed antipsychotic medications. This trend is alarming since most patients are unaware of the long-term, and possible irreversible, risks and minimal evidence of benefit.

First, there is limited and unconvincing data that antipsychotics help in eating disorder recovery. Initially, about 20 years ago, many of these medications were prescribed because of the side effects of increased appetite and weight gain. The clinical reasoning was that weight would help with recovery. In fact, the opposite is true. The side effects only galvanize the eating disorder thought process and lead to immediate return of symptoms after discharge.

Currently, this class of medication is used because of the theory that it will decrease obsessive thoughts about food. Again there is no compelling evidence to justify this conclusion so the next logical step is to question why antipsychotics are prescribed so liberally in treatment programs.

The first reason is the overall difficulty of treating eating disorders. The frustrations, especially around medication efficacy leads prescribers to search for any medication that may help. The truth is that medications only help with symptoms peripheral to eating disorders such as depression and anxiety. If prescribers accept this reality, they will quickly curtail use of antipsychotics.

The second reason is the hidden expectation of increased appetite and weight gain. Frequently, patients aren’t told this is the case which in and of itself is unethical. Any change in appetite and weight gain will give the illusion of recovery and hasten discharge. These decisions clearly don’t help recovery or long-term health but only serve the immediate purpose of the program.

The third reason is the pressure from pharmaceutical companies. Because these medications are expensive, it behooves the companies to encourage increased prescribing. Clinicians need to be aware of the lack of evidence that antipsychotics help with eating disorder and only use them when warranted.

None of the reasons for increased antipsychotic prescribing for people with eating disorders enhances recovery. And in order to make these medication decisions, most patients are unaware of the potential side effects.

Increased appetite and weight gain are common side effects with all medications in this class. The unwanted changes only solidify the eating disorder thoughts and prolong the path to recovery.

Antipsychotics can affect reproductive hormones significantly and disrupt regular hormone fluctuation through the month.

These medications can also cause movement disorders such as muscle stiffness, agitation and restlessness which are very uncomfortable. Although a rare side effect, tardive dyskinesia is a permanent movement disorder typically consisting of involuntary movements of the fingers, toes or mouth. Very occasionally, people can develop tardive dyskinesia from just one dose of an antipsychotic.

An important step for treatment programs is to recognize the value and limitations of medications to treat the symptoms of eating disorders. Overprescribing antipsychotic medications with concerning side effects needs to stop. Oversight at the programs by more experienced clinicians can alter these practices quickly.