Eating Disorder Referral and Information Center
International Eating Disorder Referral Organization
Medication and Eating Disorders
Medication and Eating Disorders by
byMary Anne Cohen, Director of The New York
When I suggest to patients that medication might be helpful for their eating disorder, they often ask, “If I take medication, aren’t I just turning to a pill as a crutch just like I’ve always turned to food? Aren’t I just substituting one dependency for another?”
My answer is that prescribed medication can be a helpful tool for a person with an eating disorder. Not all eating disorders stem from emotional issues. Eating disorders are complex problems that are often caused by a biochemical imbalance within the person. When a biochemical imbalance does exist, medication can help alleviate the struggles of bingeing, purging, and starving.
If our inner chemistry is not well regulated, we may not have the resources to face the underlying emotional issues and habits fuelling our eating problems.
Many of my patients who have been on medication have said to me: “I used to be so depressed. All I wanted to do was binge and sleep. I felt a heavy curtain between me and the rest of the world. Now, with medication, that curtain has lifted and I feel hopeful for the first time in ages. I feel more like the me I used to know!”
Over the past twenty-five years, scientists have made great strides in understanding how the brain works. Their research has demonstrated how hormones, neurotransmitters, and enzymes affect our behavior.
The pathways in the brain that regulate our eating behavior are made up of chains of nerve cells. Messages are passed from one cell to another by chemicals called neurotransmitters. If a chemical imbalance exists in the brain because of an abnormal level of neurotransmitters, these pathways can go awry and lead to eating disorders and/or depression. Medications such as anti-depressants can be used as a way of re-regulating the amount of chemicals in these brain pathways. Rather than being a crutch, they “remind” the body of the correct route and gently nudge one’s inner chemistry back to a more optimum state.
Researchers have also discovered that certain foods enhance chemicals in our brain which improve our mood and state of well being. Foods rich in carbohydrates, for example, act as natural tranquilizers. They can trigger the release of neurotransmitters which, in turn, elevate our mood and make us feel better. So when we binge on cookies or bread we are unconsciously trying to medicate ourselves for anxiety or depression without even knowing it. Cookies do lift the spirits—but only temporarily.
Medication may benefit eating disorder patients in several different ways. In some cases, it may directly reduce the eating disorder behavior of bingeing, purging, or starving. In others, it may relieve the symptoms of depression, anxiety, obsessive compulsive disorders, or premenstrual syndrome. These are the symptoms that often accompany and even give rise to eating disorder behavior.
Medication for Bulimia, Binge Eating Disorder, Anorexia
Let’s examine the role of medication in bulimia, binge eating disorder, and anorexia. Of these three eating disorders, bulimia has proven to be the most responsive to treatment with medication. Bulimics often come from families that suffer from alcoholism and depression. This indicates that there may be strong, underlying genetic components causing these three diseases. Both depressed and non-depressed bulimics seem to improve with anti-depressant medication which can significantly reduce the urge to binge and purge.
Since binge eating disorder was not considered a specific medical diagnosis until 1994, there has not been as much research on the treatment of binge eating with medication. But evidence indicates that compulsive overeaters can be helped by the same medications used to treat bulimia. With enhanced levels of serotonin (one of the neurotransmitters) in our bodies, the urge to binge and eat compulsively may be diminished.
The treatment of anorexics with medication is not as clear-cut because malnutrition itself can lead to the symptoms of depression, confusion and obsessive preoccupation so often seen in these patients. Restoring an anorexic’s weight to a more normal range is crucial because with adequate nutrition, some or much of the anorexic’s depression may abate. Once the malnutrition is overcome, it is possible to evaluate more accurately which of the anorexic’s symptoms were related to physical starvation and which are emotional and need to be dealt with in psychotherapy.
Researchers have hypothesized that the anorexic may respond to the same medications prescribed for the obsessive compulsive because both are constantly preoccupied with perfectionism and driven by obsessive thoughts.
Medication and Emotions
Not only can medications be helpful for some people in controlling their eating struggles with bingeing, purging, or starving, they can help in other ways as well. Eating disorder patients experience a high incidence of depression, anxiety, panic disorder, obsessive compulsive behavior, and premenstrual syndrome. In relieving these symptoms, medication may also, in turn, diminish the eating behavior.
Research shows that almost three quarters of all anorexics and bulimics suffer from a depressive disorder. Clinicians also report that a significant number of compulsive eaters suffer from depression.
Biologically based depression, which is related to abnormal chemical functioning, is different from the normal emotion of depression that many of us feel from time to time. It is sometimes difficult to distinguish what is biologically based without professional help. In fact, at times, an emotional depression can actually trigger internal chemical changes.
Eating disorder patients may suffer from different types of depression:
A major depression refers to an acute episode of depression lasting more than two weeks with five of the following symptoms:
(1) depressed mood.
(2) a lack of interest or pleasure in life.
(3) a significant weight loss or weight gain not related to dieting.
(4) an increase or decrease of appetite every day.
(5) insomnia or oversleeping every day.
(6) psychomotor agitation or retardation every day (feeling “hyper” or dragged out).
(7) fatigue or loss of energy every day.
(8) feelings of worthlessness or excessive or inappropriate guilt.
(9) diminished ability to think, concentrate, or make decisions.
(10)recurrent thoughts of death, suicidal thoughts, or suicidal behavior
Dysthymia or depressive neurosis is another type of depression. This refers to a chronic state of depression that has lasted for at least two years. Even the person’s achievements and successes do not alleviate the depression, except temporarily.
Bipolar depression is a disorder in which the person’s mood swings between lows and highs, ranging from deep depression to inappropriate elation (formerly called manic-depressive illness).
Atypical depression tends to be chronic and more common in bulimics. Symptoms include increased appetite, weight gain, bingeing, excess sleeping, heaviness in the arms or legs, and sensitivity to rejection, particularly romantic rejection. (It is called atypical depression because it is the opposite of typical depression which usually involves loss of appetite, weight loss, and insomnia.)
Seasonal Affective Disorder (SAD) is another form of biological depression often connected with eating disorders. It resembles atypical depression, but only occurs during autumn and winter months and abates with the increase of sunlight in spring and summer. Seasonal Affective Disorder improves with light therapy as well as medications.
Premenstrual syndrome (PMS) refers to a wide range of symptoms that women suffer during the week prior to their monthly period. For many women, premenstrual syndrome often worsens their eating problems, although these symptoms usually lessen dramatically a day or two after the onset of the period.
In addition to depression, patients with eating problems often suffer from panic disorders, obsessive compulsive disorder, and anxiety. Medication can be prescribed to target these symptoms of each individual person.
Is Medication for you?
How do you decide if you can be helped by medication? The first step is to consult with a psychotherapist. In my practice, I try to determine the degree of a patient’s suffering in order to evaluate whether we should first give psychotherapy a chance or to proceed with a medication evaluation with a psychiatrist.
If, after this initial therapy (about three months), there is no change in eating behaviors, I then suggest a consultation for medication.
Sometimes, however, it is clear from the start that a person’s depression, anxiety, or panic are out of control, or she is struggling with suicidal impulses, or she is cutting herself or engaged in other self-harm behavior. Such cases need to be assessed for medication at once. Also, anorexics who have suffered life-threatening weight loss or bulimics with severe medical complications will also require a medical evaluation. Sometimes an immediate hospitalization may even be necessary to help someone stabilize a medical or psychological crisis.
If the therapist is a non-medical professional, such as a social worker or psychologist, and an evaluation for medication is indicated, the patient will be referred to a psychiatrist who is a medical doctor licensed to prescribe medication. The therapist and psychiatrist will then work hand-in-hand as a team. It is especially helpful to work with a psychiatrist who has expertise in the treatment of eating and mood disorders.
How long will I need medication?
Medication requires a certain length of treatment, usually six months. A trial of less than six months may not be as helpful nor will the benefits be sustained for as long. If, after a six month period, the patient’s eating disorder and mood is improved, medications can be tapered off.
Many patients are able to sustain the benefits after their first trial, but may occasionally relapse because the re-regulation of their inner chemistry does not persist. Medication then needs to be continued for another course of treatment.
Trying to “tough it out” without medication may sound admirable, but, in many cases, will not provide relief. A biological illness does not improve through willpower.
If your therapist and doctor agree that you could be helped by medication, it is worth a try. Medications alone are not as effective as medication coupled with psychotherapy.
Ongoing research continues to shed light on the complexity of eating disorders and their biological underpinnings. Leaving no stone unturned to heal your eating problems, such as a trial run of medication, can be a truly compassionate act in your own behalf.
Mary Anne Cohen is director of The New York
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