SYMPOSIA

Psychopharmacological treatments in eating disorders
Alican Dalkilic
St. Elizabeths Hospital, Washington, DC 20032, USA
E-mail: drdalkilic@gmail.com
Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Abstracts of the Invited Speakers
Pharmacological treatment options have limited evidence of benefit in treatment of eating disorders, yet a comprehensive psychiatric
evaluation besides a physical exam and basic screening tests (complete blood count (CBC), basic metabolic panel, Mg, P, thyroid
stimulating hormone (TSH), lipid panel, pregnancy test, urine analysis (UA), urine drug screen (UDS), ECG, and Dexa scan) should be
conducted. Establishing a therapeutic alliance with empathy, positive regard, reassurance, and support (1) sets up the foundation for a
successful treatment process. The patient’s safety should be evaluated with particular attention paid to suicidal ideation, plans, intentions,
history of attempts and impulsive or compulsive self-harm behaviors. After assessing eating disorder symptoms, signs, and behaviors and
the general medical condition of the patient a decision about treatment site (specialized inpatient unit, residential treatment or partial
hospital program, intensive outpatient, or outpatient care) can be made. In eating disorders in general, but especially in adolescences with
eating disorders, inclusion of the family and primary support group in the treatment process is essential.
The treatment options and goals in eating disorders include nutritional rehabilitation, psychosocial interventions, medications, and other
somatic treatments. Nutritional rehabilitation aims to restore weight, normalize eating patterns, achieve normal perception of hunger
and satiety cues, and correct biological and psychological problems caused by malnutrition (1). Psychosocial interventions include
individual and group based cognitive behavioral and interpersonal therapies, acceptance and mindfulness therapies, and psychodynamic
approaches, as well as nutritional counseling, dialectical behavioral therapy (DBT), and family therapies. There are more therapies with
specific names such as mealtime support and multifamily group therapy, but they use similar approaches to the previously mentioned
ones.
Although there is clinical evidence about use of antidepressants in treatment of eating disorders (especially SSRIs, calcium, vitamin D,
and zinc and limited data about benzodiazepines, mood stabilizers, and atypical antipsychotics), so far only fluoxetine is approved for the
treatment of bulimia nervosa by the Federal Drug Administration (FDA) 1,2). Sertraline has been found to be effective in a randomized
and controlled trial, as well. Medications have not been proven to be more effective than psychosocial interventions in treatment of eating
disorders so far. Some studies have found the combination of CBT with medication to be more effective. Topiramate has been found to
be effective in some small controlled trials especially in reducing binging behavior, but due to potential side effects is should be reserved
as a secondary medication (1,3). Topiramate or zonisamide are prescribed to target binging behavior and also for weight reducing effects
in patients who may benefit from weight loss. Bright light therapy is another intervention demonstrated to decrease binge frequency in
several controlled trials (1).
Although clinicians are advised to use caution when prescribing medications to eating disorder patients due to potentially dangerous
medical co-morbidities, some medications should be avoided or used only as last resorts. Bupropion is contraindicated in bulimia due to
a heightened seizure risk (1,3). Medications that increase the risk of arrhythmia or prolong the QTc interval should be avoided or if they are
used, adverse events should be monitored closely. Sibutramine was taken off the market in USA in 2010 due to cardiac adverse events. In
addition, medications with a narrow therapeutic range such as lithium should be avoided. Benzodiazepines, especially the ones with high
addiction potential, should not be used in patients with addiction risk. In clinical practice many eating disorder patients end up being on
multiple medications due to high rates of co-morbidity with anxiety and mood disorders, substance abuse and dependence conditions,
trauma related disorders, and personality disorders. Beside reviewing pharmacological treatment options in eating disorders we will also
discuss the management of cases with co-morbid conditions.
Key words: Eating disorders, pharmacology, pharmacotherapy, treatment, pharmacological treatment
References:
1. American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders Compendium. American Psychiatric Association 2006 1,612
pages ISBN 978-0-89042-385-1.
2. Pharmacotherapy of eating disorders. Jackson CW, Cates M, Lorenz R. Nutr Clin Pract. 2010 Apr;25(2):143-59. Review.
3. Psychopharmacology of eating disorders in children and adolescents. Golden NH, Attia E. Pediatr Clin North Am. 2011 Feb;58(1):121-38, xi. Review.
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S93
S93