In this section, pharmacotherapy will be discussed for anorexia, bulimia, and binge-eating disorder.
For anorexia nervosa, in the acute phase, no medication has been found to be effective. For patients with primary or secondary depression, in addition to the anorexia, an antidepressant may be tried. Usually, the serotonin reuptake inhibitor class is used. This class includes: fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). The serotonin-norepinephrine reuptake inhibitor class may also be tried: venlafaxine (Effexor), or duloxetine (Cymbalta). When there is a component of obsessive compulsive behavior, these medications, at higher doses, may be helpful.
For weight-recovered anorexics, fluoxetine at a dose of 60 mg. has been shown to reduce the recurrence of the illness. In the acute phase of the illness, if the patient is willing to try a medication that often causes weight gain, an “atypical antipsychotic” such as olanzapine (Zyprexa), or risperidone (Risperdal) or quetiapine (Seroquel) may be tried, to decrease the anxiety and tension surrounding eating, and allow the person to eat more easily. However, most patients refuse these medications due to the side effect of weight gain.
There is no medication shown to be effective in treating anorexia. The pharmacological treatments are supportive, often focusing on the other symptoms surrounding the main one, such as not eating. Medications that increase appetite have also been tried, but with very limited success (eg. Peri-actin).
Of course, people with anorexia often develop symptoms of bingeing and purging, and at this point, medications for bulimia may become effective.
For bulimia, the serotonin reuptake inhibitors have been shown to be effective, especially fluoxetine and sertraline. Older medications, the tricyclic antidepressants, especially imipramine, were used before the advent of SRI’s, and were proven effective in treating bulimia. However, the tricyclic antidepressants are much more difficult to take, due to side effects and the potential for fatal cardiac arrhythmias, especially in people who are bingeing and purging. These meds have largely been supplanted by the SRI’s and SNRI’s. Binge-eating disorder may also be treated with serotonin reuptake inhibitors. Bupropion (Wellbutrin) is specifically contraindicated in bulimia, due to the potential for seizures with this medication.
For people who are abusing alcohol or other substances as part of the picture of their eating disorder, there are a number of medications that might be tried, including Naltrexone (ReVia), disulfiram (Antabuse), and acamprosate (Campral). A full discussion of these meds goes beyond the scope of this section.
There have been multiple medications tried for obesity, including the infamous Phen-Fen combination, as well as Redux. These have been proven to be dangerous and not effective in the long run. For morbid, life threatening obesity, the only effective and evidence-based treatment is surgical, and this treatment is not without major complications and mortality risk.
Medications may be effective, but should always be used in conjunction with other forms of treatment, including CBT and supportive therapies. The only class mentioned above that is FDA approved for the treatment of eating disorders is the serotonin reuptake inhibitor class; the other medications mentioned are used “off-label.”
Margaret S. Ross
Director, Behavioral Medicine