Can Medication Help Recovery?
Even the strongest proponents of pharmacotherapy do not recommend treatment based entirely on medication. No ‘magic pill’ can fully resolve the emotional and spiritual issues underlying bulimic behavior; therapeutic drugs should be just one part of a multidisciplinary treatment approach. Still, antidepressants particularly fluoxetine (brand name Prozac®) are often used in the treatment of select patients with bulimia.
Although these drugs are termed antidepressants, they are just as useful for bulimics who are not depressed. Medication may enable a patient to benefit from the other components of treatment. For example, medication and Cognitive Behavioral Therapy (CBT) are mutually reinforcing. It is important to note that many patients who have taken these medicines, but not in the high doses required for bulimia, mistakenly feel they can’t be helped by them.
Currently, fluoxetine is the only FDA-approved drug for treating bulimia, but not the only one routinely prescribed. It is in the class of selective serotonin reuptake inhibitors (SSRIs), which increase levels of serotonin in the brain. The side-effects of fluoxetine are relatively benign compared to other antidepressants, anticonvulsants, or monoamine oxidase inhibitors (MAOs). While the course of drug treatment usually begins with fluoxetine, when the patient has concurrent symptoms of other psychiatric disorders or does not respond well to fluoxetine, other remedies are considered (Broft, 2010). Primarily physicians, such as psychiatrists or in some jurisdictions Master Level Nurse Practitioners who are also knowledgeable about eating disorders should prescribe these medications.
In many cases, bulimics respond well to non-pharmaceutical treatment as an alternative to drug therapy. In fact, the American Psychiatric Association guidelines for treating bulimia recommends delaying the initiation of medications to see if therapeutic approaches particularly CBT are successful (APA, 2006). However, when patients prefer a pharmaceutical approach, it is appropriate to begin at the same time as talk therapy. Other reasons to include medications initially would be severe bulimic symptoms or significant comorbidity, such as being so depressed, anxious, or obsessional that a patient can’t get the full benefit of therapy.
Some bulimics respond well to drug treatment and reduce their cravings to binge within weeks. Many of these people have a history of depression, although being caught in the cycle of bulimic behavior can certainly cause depression, as well. Some bulimics benefit from medications because the chemical changes in their bodies increase their ability to feel hunger and fullness. I’ve also heard from many women who indicated that drug therapy decreased their cravings to binge, allowing the issues that fueled the binge-purge behavior to surface and be resolved. Recognizing that food is medicine and a bulimic’s body is lacking key nutrients, dietitians on a treatment team will provide well-balanced menu plans, and some practitioners recommend nutritional supplements and amino acids. Although select people respond well to supplements, they are not evidence-based treatments, meaning their efficacy has not been proven by clinical trials.
Two of many psychiatrists I tried were biochemically oriented, and willing to modify pharmaceutical rules based on their own experience. We kept trying different doses and medicines until something worked.
I started using Prozac, and it really helped me. My urge to binge lessened practically overnight. It made me feel more ready for therapy.
I am being treated with Zoloft, which has changed my life. It offers a normal mood, as well as freedom from binges. Of course, therapy in conjunction with medication is the ideal situation, and I’m trying that too. I don’t think one without the other would do.
Reprinted with permission from Bulimia: A Guide to Recovery
By Lindsey Hall and Leigh Cohn
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