Medications for Eating Disorders

Eating disorders are psychiatric disorders that involve serious medical and nutritional complications.¹ Behavioural treatments for eating disorders often begin with nutrition rehabilitation and normalization of eating patterns, however the occurrence of non-response or resistance to treatment often persists. By identifying mental illness medications that can be used as primary or adjunctive treatments, it may be possible to improve the effectiveness of eating disorder treatment by combining traditional treatment methods with the use of pharmacological agents.¹

A study by MacNeil and Thib (2022) examined the proportion of Canadian adults who were on psychiatric medication prior to entering specialized outpatient care for an eating disorder. More than half of participants were prescribed psychiatric medication prior to entering specialized outpatient care. Antidepressant and antianxiety medications were the most common. The most frequently prescribed included escitalopram, fluoxetine, citalopram, and sertraline.

When looking at adolescents and young adults, Mizusaki et al. (2018) found that 45% of them were taking psychotropic medication prior to presenting to an eating disorder program. Another study by Garner et al. (2016) identified that 80% of adolescents admitted to a residential program were taking psychotropic medication upon admission, with the most common being antidepressants.

Anorexia Nervosa (AN)

Olanzapine (Zyprexa®) appears to have a modest effect on weight restoration in AN.¹ The antipsychotic medication olanzapine is the only medication to demonstrate efficacy in promoting weight gain among individuals with AN, though it does not appear to yield significant effects on psychological symptoms.¹ In children and adolescents, olanzapine is the most commonly studied psychotropic medication in those living with anorexia nervosa.⁴

Few studies exist on the use of quetiapine (Seroquil®) for the treatment of AN, though a study by Mehler-Wex et al. (2008) found that it improved body image, weight phobia, and “paranoid ideas”. It has been found that aripiprazole may benefit adolescents by aiding in weight gain and improving eating disorder cognitions.⁶

Bulimia Nervosa (BN)

Fluoxetine’s (Prozac®) efficacy and tolerability together with it being the only FDA-approved treatment for BN contribute to it being a first-line medication considered for BN treatment.¹ Selective serotonin re-uptake inhibitors (SSRIs) have shown the most promise for children and adolescents with bulimia nervosa (BN) through reducing the frequency of binge and purge episodes, though there is limited evidence.⁴

Binge Eating Disorder (BED)

While lisdexamfetamine (more commonly known as Vyvanse®) is the only currently FDA-approved medication for BED, certain antidepressants and anticonvulsants are also generally well-tolerated and can demonstrate modest effects on binge eating.¹ Lisdexamfetamine should be considered for adults with BED, with careful attention paid to vital signs and cardiovascular health as these health measures may change in a high-risk patient taking a stimulant.¹

SSRIs considered for off-label use in BED will likely offer benefits without cardiovascular health risks.¹ SSRIs may also be particularly useful for adults with co-occurring mood or anxiety symptoms in addition to BED.¹

There are no known studies that address psychopharmacologic treatment of binge-eating disorder in children and adolescents, and thus lisdexamfetamine has not been approved for use in children.⁴

Other

The pharmacological management of AN, BN, and BED has been extensively studied. However, there is limited evidence regarding the use of medication in the treatment of additional eating disorder diagnoses, such as avoidant-restrictive food intake disorder (ARFID) and the other specified feeding and eating disorders.¹ Though, olanzapine (alone and in combination with other medications) has shown benefits including an increase in weight and improved anxiety and depressive symptoms in those living with ARFID.⁴

Conclusion

Much of the research on pharmacotherapy of eating disorders in children has been focused on the role of antipsychotic medications in AN.⁴ There is still insufficient evidence to recommend any medications as first line treatments for children and adolescents.⁴ Psychopharmacological treatment of eating disorders continues to be an area of great interest and study moving forward.¹

Are You Interested in Learning More?

At Change Creates Change Eating Disorder Care, we strive to educate other healthcare professionals about eating disorders. If you are interested in learning more, you can click below to register for our First, Do No Harm, free webinar for health professionals that will help you navigate what to do if one of your patients is living with an eating disorder.