Eating disorders medical treatment

When is medication indicated in the treatment of psychiatric illness There is no short answer to this question. At one end of the continuum, patients with schizophrenia and other psychotic disorders, bipolar disorder, and severe major depressive disorder should always be considered candidates for pharmacotherapy, and neglecting to use medication, or at least discuss the use of medication with these patients, fails to adhere to the current standard of mental health care. Less severe depressive disorders, many anxiety disorders, and binge eating disorders can respond to psychotherapy and/or pharmacotherapy, and different therapies can target distinct symptom complexes in these situations. Finally, at the opposite end of the spectrum, adjustment disorders, specific phobias, or grief reactions should generally be treated with psychotherapy alone. 

If relapse does occur, it should first be determined whether the patient was compliant with treatment. If the patient was not compliant, antidepressant medication should resume. If the patient was compliant and had been previously responding to the medication (without significant side effects), the existence of ongoing stressors (e.g., conflict, abuse) or comorbid medical or psychiatric disorders should be considered (anxiety disorder, ADHD, substance abuse, dysthymia, bipolar disorder, eating disorder). 

Hospitalization for eating disorder depends on the weight status of the patient, the presence of medical complications, and the presence of related psychiatric comorbidities, such as depression, suicidal behavior, and OCD. Hospitalization for AN may be brief or extended. Inpatient brief hospitalization (7-14 days) is for patients who have (1) relapsed from previous treatment or have been ill for less than 6 months (2) a weight loss of 10%-15% from normal weight if they have relapsed, or 16%-20% if this is their first episode (3) hypokalemic alkalosis with serum potassium < 2.5 mEq/L and (4) cardiac arrhythmias. To promote rapid weight gain, patients can be placed on a liquid formula... 

Psychotropic medication use is associated more with causing difficulties with eating rather than as a treatment for eating disorders. None of the medications investigated in the treatment of primary anorexia nervosa have been shown to be efficacious. Pica is defined as the eating of non-food substances. In the Expert Consensus survey (Rush and Frances, 2000) 63% of the respondents stated that no medication treatment is indicated for this disorder. Should medication be considered, then SSRI medications were most commonly endorsed. Another alternative is treatment with mineral or nutritional supplements, such as zinc or iron. 

A meta-analysis of eating disorder programs suggests that medications alone fail to produce consistent weight gain in anorexia nervosa ( 510). Better results appear possible if medication is integrated into a comprehensive treatment approach, which includes the following ... 

The role of medication in the treatment of bulimia nervosa seems better established than its role in the treatment of anorexia nervosa. The American Psychiatric Association Practice Guideline for Eating Disorders ( 510) suggests that antidepressants may be useful in bulimia nervosa with or without depression. They may be particularly helpful, however, in those with depression, anxiety, obsessions, or who have failed psychosocial therapies. 

Jimerson DC, Wolfe BE, Brotman AW, Metzger ED. Medication in the treatment of eating disorders. Psychiatr Clin North Am 1996 19 739-754. 

Green RS, Rau JH. Treatment of compulsive eating disorders with anticonvulsant medication. Am J Psychiatry 1974 131 428 32. 

Introduced in 1988, Prozac is the oldest in the SSRI class and is still the most commonly prescribed (Morris, 1999). Prozac is a highly successful antidepressant that has revolutionized the treatment of depression because of its ability to raise serotonin levels in the brain. Increased availability of this neurochemical has been directly related to addressing effectively the symptoms prevalent in depression, and Prozac was recently approved to treat obsessive-compulsive disorder and the eating disorder bulimia. Prozac and the other SSRIs are also considered the medication of choice for working with depressed older individuals because of fewer side effects than the tricyclic medications (Haider Miller, 1993). In 1999 Prozac was endorsed by the FDA as being especially effective for geriatric depression (Hussar, 2000). 

Anticonvulsdnts. An early observation that BN patients may have abnormal electroencephalogram (EEG) resnlts led to specnlation that binge eating may represent an atypical behavioral presentation of seiznre activity. Thus, the first controlled medication study for the treatment of BN evaluated the use of the antiseizure medication phenytoin (Dilantin). Phenytoin was not found to be significantly superior to placebo, and the earlier reports of EEG abnormalities were not confirmed. The results of a subsequent trial of carbamazepine (Tegretol), an anticonvulsant that has been reported to be effective in the treatment of bipolar disorder, were also disappointing. As a result, anticonvulsants are not routinely used in the treatment of BN. 

Anorectics often exhibit a host of obsessions and compulsions (regarding eating—sizes and portions, times for meals, body weight)—yet two notable differences exist between anorectics and OCD patients. Obsessive-compulsive disorder patients almost always admit that the worries and rituals are irrational, whereas most anorectics don t appreciate the irrationality of their acts. Also, medications found to be effective for OCD generally are not effective in the treatment of anorexia nervosa. 

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