Eating disorders are the result of a multifaceted overlap of biological, psychological, and social factors. While psychotherapy can help address the psychological and social aspects of such disorders, pharmacological treatment (i.e. medication) can be useful in addressing their underlying biological components. Unfortunately, research investigating the pharmacotherapy of eating disorders is scarce and requires further study. Moreover, each type of eating disorder has a unique symptomology and trajectory, and therefore a medication that can help in the treatment of one disorder may not necessary be effective for another. In their review of the psychopharmacologic treatment of eating disorders, McElroy and colleagues (2015) evaluated clinical studies that included randomized controlled trials (RCTs) in which individuals with eating disorders were given either a psychiatric drug for their treatment, or a placebo. The researchers summarized their findings of the efficacy of various medications for eating disorders, and categorized them by the specific disorder:
Anorexia Nervosa (AN)
Antidepressants: McElroy and colleagues (2015) described that antidepressants, including tricyclics and selective serotonin reuptake inhibitors (SSRIs) do not particularly target the unique symptoms of AN – for instance, they do not help with gaining weight or preventing relapse. However, they reported that antidepressants can help with related or co-occurring symptoms of AN, including depression and obsessive-compulsion.
Second Generation Antipsychotics (SGA): In their review, McElroy and colleagues (2015) report that RCTs have generally produced mixed results in reducing eating disorder symptoms. In general, they have not proved effective for weight gain or psychological symptoms in AN; however, certain studies have demonstrated that one SGA, olanzapine, can be effective for weight gain in AN, especially if used without other psychosocial interventions.
Other Medications: McElroy and colleagues’ review (2015) also included other medications used in the treatment of AN. For instance, they described the use of dronabinol, a synthetic cannabinoid, which has demonstrated a potential for weight gain in AN patients. Moreover, estrogen replacement, while it does not contribute to weight gain in AN, can help reduce trait anxiety associated with AN.
Bulimia Nervosa (BN)
Antidepressants: McElroy and colleagues (2015) referred to RCTs that demonstrated that tricyclic antidepressants, SSRIS, and topiramate are effective in reducing binging and purging behaviors in BN. In fact, fluoxetine is indicated for the treatment of bulimia, and is the only medication specified for the treatment of any of the eating disorders.
Other medications: McElroy and colleagues (2015) also reported that ondansetron, an antinausea medication, has demonstrated efficacy in reducing behaviors of BN.
Binge Eating Disorder (BED)
Antidepressants: Just as with the other eating disorders, antidepressants may also help with treatment of BED. McElroy and colleagues (2015) reported that the antidepressant duloxetine, a serotonin norepinephrine reuptake inhibitor, was helpful compared to a placebo in reducing the following symptoms in BED: weekly frequency of binge days, frequency of binge episodes, and overall severity of BED and depression symptoms. In addition, sertraline and topiramate have demonstrated efficacy in BED improvement.
Lisdexamfetamine: McElroy and colleagues (2015) reported evidence that lisdexamfetamine, an amphetamine, was helpful in reducing binge eating episodes in BED.
Intranasal naloxone: They also described a placebo-controlled study in which individuals with BED sprayed intranasal naloxone, an opioid antagonist, prior to a binge episode. Compared to those in the placebo group, these participants demonstrated a greater decrease in their time spent binging.
Other Eating Disorders
McElroy and colleagues (2015) referred to the paucity of RCTs evaluating the efficacy of medications for other eating disorders, including avoidant restrictive food intake disorder, purging disorder, and pica. They did refer to RCTs of night eating syndrome, and that sertraline and pramipexole have demonstrated effectiveness in reducing symptoms.
In conclusion, although research is limited regarding medications in the treatment of eating disorders, including psychiatric care in your treatment can definitely address biological factors of your disorder, or other co-occurring disorders, that psychotherapy cannot necessarily target. Having a team of professionals including a psychotherapist, psychiatrist, and dietician can be very effective in coordinating your care and creating a strong system of support in your recovery.
Bio: Bahar Moheban, M.A. is a clinical psychology doctoral candidate and registered psychological assistant in Torrance under the supervision of Dr. Nazanin Moali. She provides individual and group psychotherapy to adults and adolescents with disordered eating, negative body image, and comorbid disorders. If you believe you may be struggling with an eating disorder, and are seeking a more peaceful relationship with food and your body, contact Bahar for a counseling appointment.