Medication for eating disorders

How eating disorders are treated with medication

There are very few medications currently approved to treat eating disorders outright. Instead, most medications prescribed to those with eating disorders aim to treat co-occurring conditions common in eating disorders, such as anxiety and depression. 

The prevailing belief is that treating these co-occurring conditions can help alleviate eating disorder symptoms. For example, treating anxiety or depression may help elevate someone’s mood and increase their sense of motivation, which can help them overcome or more easily work through disordered eating behaviors.

How to get prescribed medication for eating disorders

Generally, the process begins with a medical evaluation with a prescriber, like a physician or a nurse practitioner. Your primary care physician (PCP) or psychiatrist may interview you and/or run a series of tests to determine whether they think you would be a good candidate for medication.

Professionals may ask questions regarding:

• Your eating habits
• The presence of compensatory behaviors, like vomiting or laxative use
• The frequency, intensity, and duration of mental health symptoms
• The presence of physical health complaints

Your healthcare provider may order lab tests to ensure your liver and kidneys function well enough to metabolize and process certain drugs. They'll likely also ask about your medical history to ensure you haven't experienced negative reactions or allergies to certain medications.

Once you've started taking the medication, you'll likely also be scheduled for regular follow-up appointments with your provider to ensure the medication is working, you're not experiencing any negative side effects, and to continue monitoring dosage and need. These could occur at a biweekly, monthly, or quarterly schedule.

Common types of medication for eating disorders

Very few medications have been approved by the Food and Drug Administration (FDA) to treat eating disorders specifically. Rather, most pharmacological options aim to curb specific symptoms or to help patients manage common comorbid or co-occurring conditions, such as depression or anxiety. 

Medications for different eating disorders

Again, very few drugs are currently approved to treat eating disorders directly. However, some medications are more commonly prescribed for people with certain disorders.

What to expect when taking medication for eating disorders

When taking medication of any sort, it's best to be careful and follow medical advice and directions as closely as possible. Although medications are generally safe and effective, they can sometimes have side effects and create other changes in mood or daily schedule.

Many medications cannot be abruptly stopped without experiencing withdrawal symptoms. This can be particularly problematic with antidepressants, as the body and brain may go through rebound anxiety, panic attacks, and a resurgence of disordered behaviors if not correctly tapered off of the medication.²

Several medications, particularly antidepressants, also need time to build up in the system before producing the desired effect. This can make the intervening weeks of taking the meds before they kick in a particularly vulnerable time. Make sure to address any concerns you may have about this window with your doctor.

Medications used to treat binge eating, anorexia nervosa, and bulimia nervosa can frequently have harmful interactions with other drugs.^2,3,4 Be sure to bring a complete list of all medications you're currently taking along with the dosage, route of administration (pill, patch, etc.), and frequency (once daily, twice daily, etc.) to your appointment.

Potential side effects of medication for eating disorders

Medication side effects can vary dramatically based on the type of drug being used and the medical history of the individual using it, among other factors.

Some common effects of SSRIs include:¹⁰

• Dry mouth
• Drowsiness
• Headache
• Nausea, vomiting or diarrhea
• Insomnia
• Nervousness, agitation, or restlessness
• Dizziness
• Sexual problems, such as low sex drive, difficulty reaching orgasm, and erectile dysfunction

SNRIs share many of these potential side effects but may also cause:¹³

• Excessive sweating
• Fatigue
• Constipation
• Loss of appetite

Both first- and second-generation antipsychotics may cause several other side effects, including:¹⁵

• An inability to hold still
• Uncontrolled movements or twitching in the face
• Altered heart rhythm
• Blood pressure drops when standing or sitting up, which could lead to fainting
• Increased cholesterol and blood sugar
• Dizziness
• Fatigue
• Fertility issues, including missed periods in biological females and infertility in biological males
• Jaundice
• Weakened immune system
• Constipation

Generally, less serious issues will go away within a few days or weeks after your body adjusts. If they persist, it's imperative to contact your physician.

Sometimes, side effects may persist as long as you take the medication. It's best to understand these potential issues and carefully weigh the pros and cons with your doctor or treatment team. It will also be important in these cases (and all cases) to consistently check in with your doctor to monitor side effects.

Benefits of taking medication for eating disorders

Medication is often not the first line of treatment for eating disorders. Most doctors will at least attempt to approach the conditions with psychotherapy and other types of help to start. However, for some patients, therapy is not enough.

Some patients may experience co-occurring issues that make recovery more difficult but which can be addressed with medication. For example, medication can be used to treat symptoms of depression or anxiety, which can help alleviate urges to participate in disordered behavior.

Your doctor can help you understand more about the benefits medication can provide in your specific case.

Limitations of eating disorder medication

Medication changes aspects of your biochemistry. Some patients may be uncomfortable with that fact alone or about the possible side effects this can cause.

Certain medications for eating disorders have the potential to react negatively with other drugs, foods, or substances, which can make them a dangerous or tricky choice for some patients, particularly those already taking other medications.

Some drugs may take time to produce the desired effects, and others may be tricky to wean off of, especially without medical help. For these reasons and more, taking these medications strictly as recommended is always advised.

And it's important to remember that medication is not a silver bullet. In nearly all cases, patients will still be recommended to participate in at least some type of psychotherapy, whether or not they're on medication.

Is medication for eating disorders right for me?

There is no "right" or "wrong" way to treat an eating disorder. At the end of the day, each condition is as individual as the person experiencing it.

Medication may be right for you throughout your treatment, at certain points in your recovery journey, or not at all. You may try a particular prescription and not like the way it makes you feel, then decide to try a different type of medication instead. The decision is a highly personal one.

Before deciding whether medication for eating disorders is the right step for you, it's crucial to speak with your medical team. Your physician, psychiatrist, or another medical professional licensed to prescribe medication can help you understand the benefits and limitations of these drugs in your particular case and weigh the pros and cons of starting a medication regimen.

Regardless of what you decide, know that there are a variety of ways to treat an eating disorder. With help from a caring treatment team, it is always possible to recover from these conditions.

Use of medications at Within Health

Whether or not someone takes medication is an incredibly personal choice. Eating disorders were successfully treated for many years before the existence of the most commonly prescribed medications we have today.

That being said, when someone enters treatment, they often have a limited amount of time and want to get the most out of the precious time they have at PHP and/or IOP. Medication can be a beneficial tool for allowing the brain to open up and do deeper work more quickly.

At Within Health, every patient in our program has a full psychiatric assessment by a licensed clinician (either a psychiatrist or a psychiatric nurse practitioner) who will make appropriate recommendations. Some individuals do not want to take medication; we will always respect that. Others want to be treated with medications immediately, and we will help prescribe appropriate medications. Still others might have questions about medication, which we are here to answer.