Treatment options for EATING disorders

As a nutrition support pharmacist, you must have a strong medical background on the available treatments for nutritional problems. Experts are weighing in on treatment options for eating disorders. At least 2% of the population has an eating disorder.

• Anorexia nervosa patients have low body weight but don't always see themselves that way. The newest research shows drug therapy does NOT seem to help patients overcome anorexia. But SSRIs often CAN help concomitant depression, anxiety, obsessive-compulsive symptoms, etc.
• Bulimia nervosa patients binge on food, then compensate with vomiting, laxatives or diuretic abuse, fasting or excessive exercise, etc.
• Prescribe fluoxetine (Prozac) 60 mg daily. Titrate up to this dose over several days. Lower doses don't work as well.
• Preliminary evidence suggests that desipramine and topiramate might have some benefit. But save topiramate for last, due to side effects and possible weight loss. Lithium is not effective for bulimia.
• Don't use bupropion (Wellbutrin) in patients with bulimia or anorexia, due to the increased risk of seizures.
• Binge eating disorder patients binge, but don't purge. This often leads to obesity.
• SSRIs seem to work best to curb binge eating.
• Sibutramine and topiramate might help patients curb eating and lose weight, but there's not enough evidence to use them yet.
• Night eating syndrome patients will get up multiple times per night to eat. Consider sertraline (Lustral) to help curb nighttime eating. Tell patients that cognitive behavior therapy is very useful for eating disorders. Encourage them to get appropriate treatment.

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References

1. Berkman, N., et al. (2006) Evidence Report/Technology Assessment Management of Eating Disorders. [online] Available at: http://www.maudsleyparents.org/images/eatdis-1.pdf
2. Hay P. Current approach to eating disorders: a clinical update. Intern Med J. 2020 Jan;50(1):24-29.

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