Medications for Eating Disorders

Please note: In March, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants .

On June 30, 2005, the FDA issued a similar advisory regarding antidepressant use by adults, warning about a possible increase in suicidal thinking or behavior early in treatment or when dosage of the medication is changed. The advisory covers all the drugs in the above paragraph plus Cymbalta (duloxetine).

Selective Serotonin Reuptake Inhibitors (SSRIs)

*** see note above

• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Fluoxetine (Prozac)
• Sertraline (Zoloft)

Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin in the brain, a substance which plays a role in anxiety , depression , and possibly eating disorders. SSRIs can be especially helpful for bulimia , especially in patients who have not responded to psychosocial treatment . They have also been shown to be helpful for weight maintenance and for resolving mood and anxiety symptoms associated with both anorexia and bulimia. Improvement is usually seen 4-6 weeks after beginning treatment.

Possible side effects include:

• Nausea
• Diarrhea
• Insomnia
• Sexual dysfunction

Tricyclic Antidepressants

• Imipramine (Janimine, Tofranil)
• Desipramine (Norpramin, Pertofrane)

Tricyclic antidepressants are thought to regulate serotonin and norepinephrine in the brain. They may be helpful for bulimia and may be used to treat co-occurring mood or anxiety disorders. These drugs are highly toxic if taken in large doses. Therefore, they are often not prescribed for suicidal patients. Side effects are also more likely in patients who are malnourished.

Possible side effects include:

• Dizziness
• Dry mouth
• Constipation
• Difficulty urinating
• Weight gain
• Low blood pressure
• Sexual dysfunction

Atypical Antidepressants

• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
• Nefazodone (Serzone)
• Bupropion (Wellbutrin)

Atypical antidepressants affect the concentration of the neurotransmitter serotonin. They may be helpful for bulimia and may be used to treat co-occurring mood or anxiety disorders. Improvement is usually seen 4-6 weeks after beginning treatment.

Possible side effects include:

• Nausea
• Nervousness
• Diminished sex drive (except bupropion)

Appetite Stimulants

• Cyproheptadine (Periactin)

If you have anorexia nervosa, cyproheptadine is an antihistamine that may be prescribed to help stimulate your appetite. If you have bulimia, this drug is not helpful.

Possible side effects include:

• Drowsiness
• Upset stomach or stomach pain
• Dryness of mouth, nose, or throat
• Increased appetite
• Weight gain
• Thickening of mucus

New and Miscellaneous Treatments

• Topiramate (Topamax)

There is some evidence that this drug, usually used to control seizures, can also have an effect on the frequency of binging and purging behavior in bulimia. The use of topiramate remains under study, and further trials may or may not confirm benefit.

Possible side effects include:

• Drowsiness
• Nervousness
• Confusion

• “Atypical” antipsychotic medications (Olanzapine)

Olanzapine and other similar medications have shown some benefit in the treatment of anorexia nervosa. Further studies are needed to assess their value in this condition.

Vitamin and mineral supplements

• Calcium
• Vitamin D

If you have anorexia nervosa, your healthcare provider may ask you to take a calcium supplement (1,000-1,500 milligrams per day) and a multivitamin containing vitamin D (400 international units per day). These supplements help prevent bone loss that results from inadequate nutrient intake and low hormone levels seen in anorexia.