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Learn more about the results we get at Within
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Eating disorders are highly complex conditions, often developed from a combination of biological, mental, and environmental factors. In many cases, patients benefit from various treatment options to address these various causes and needs.
Generally, therapeutic methods such as psychotherapy and group therapy are recommended as first-line options for treatment. However, some patients may also benefit from medication.
Taking medication for eating disorders is a highly personalized choice. It should never be done without the express recommendation of a doctor or other medical expert licensed to prescribe medication. When and where appropriate, these medications have the potential to help patients better manage their eating disorder and develop a more positive mindset about themselves and their lives.
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.
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressants, with several different drugs falling under this category.
SSRIs help increase the availability of serotonin—a neurotransmitter responsible for mood regulation—in the brain. This has been found helpful in treating depression and some types of anxiety disorders.10
Many types of SSRIs have been examined for treating eating disorders and related depressive symptoms. At least one is currently FDA-approved for bulimia nervosa treatment, and others have been found helpful in preventing relapse for people in AN recovery.11,12
Still, certain studies have shown that SSRIs are not as effective for patients in lower-weight bodies, so they may not be prescribed until someone is farther into the recovery process.12
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are also commonly prescribed for treating depression and anxiety. They work similarly to SSRIs but also increase the availability of norepinephrine, a neurotransmitter tied to the body’s fight-or-flight response.13
SNRIs have also been found to help with chronic pain and are more likely to be prescribed to people with these types of symptoms.13 They are sometimes considered as an alternative to SSRIs.
For eating disorders, SNRIs have been used in certain studies to help patients with bulimia nervosa.14 While they’re not explicitly approved to treat BN, patients with bulimia nervosa and co-occurring depression or anxiety may be prescribed SNRIs.
Antipsychotics are a class of drugs that help regulate cognitive processes. Specifically, they help people whose thoughts may be disconnected from reality and having intrusive thoughts or those who may experience disorganized thinking or dampened emotions.
Like SSRIs and SNRIs, antipsychotic medications work by adjusting the availability of certain neurotransmitters in the brain in order to restore balance. There are several “generations” of these drugs, which work slightly differently, but they all target dopamine, a neurotransmitter connected to mood regulation.15
No antipsychotic medications are currently approved to treat eating disorders specifically, but they may be prescribed if someone has co-occurring mental health concerns such as depression and irritability. When used this way, they can also help someone manage unhelpful thoughts related to their body image or eating behavior.5
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.
Binge eating disorder (BED) is the most common eating disorder in the United States, but it is also emerging as one of the most treatable eating disorders, and a number of binge eating disorder medications are currently being developed.7 Most of these medications work to reduce binge eating behaviors by targeting the central nervous system and/or interacting with parts of the brain involved in the reward system, which commonly triggers urges to eat.1
The most common—and currently only legally approved—binge eating medication is lisdexamfetamine dimesylate, referred to by the market name Vyvanse.7 This drug is considered a controlled substance, as it includes levels of amphetamine, a federally-recognized stimulant.7 It's long been used to help people with attention deficit disorders but has also shown benefits for treating binge eating disorder.6
Experts believe the medication helps by increasing dopamine levels, which can elevate or regulate mood, leaving people less inclined to use food to produce feelings of pleasure, comfort, or satisfaction.1
Few medications are legally approved to treat bulimia nervosa (BN), though physicians may prescribe antidepressants to help. These drugs don't necessarily help reduce the urge to binge eat or purge but may help patients feel better about themselves, which can lead to the reduction of those behaviors.
Fluoxetine (Prozac) is currently the only FDA-approved antidepressant for BN.8 In one early study, the drug was found to help curb symptoms related to depression, a common co-occurring condition with BN, along with limiting disordered eating behaviors and, specifically, the craving for carbohydrates.9
Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI), which works by allowing more serotonin to be available in the brain. More serotonin can help reduce feelings of depression and anxiety.
The half-life of the drug, or how long it takes to break down in the body, is also relatively long, allowing a more forgiving effect should a patient miss a dose.6 Newer formulations allow the pill to be taken only once weekly.6
There are currently no drugs on the market approved to specifically treat anorexia nervosa (AN). Unfortunately, AN has the distinction of being one of the most difficult eating disorders to treat, along with being one of the most deadly.
Some studies have examined the possible impact of olanzapine (Zyprexa), a type of antipsychotic. The drug did have several positive effects on patients in one study, including:5
Eating disorder symptoms also decreased, with many patients achieving healthy weight gain as a result.5
While these results are encouraging, olanzapine is not yet currently approved by the FDA for anorexia nervosa treatment. Still, patients with related mental health concerns may be prescribed this medication.
Other medications, including Abilify, have also been prescribed to help with AN and related issues. Some patients may prefer these drugs, as they’ve been found to be weight-neutral. Speaking with your physician or psychiatrist is the best way to understand the type of medication that may be most helpful for you.
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.
When speaking with your doctor about a potential prescription, it's important to ask about and develop an understanding of:
What the brand and generic name of the drug is
What the drug does
How the medication will impact your body and brain
Any potential interactions it may have with other medicines or certain foods or drinks (including coffee and alcohol)
What will happen when/if you stop taking the medication
What will happen if you miss a dose
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.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
The short answer to this is NO! And if you ever feel a medication is changing who you are, it's not the right one for you.
If I take medication, isn't it just the medication doing the work for me?
Absolutely not! We can view medication like a life jacket. If you were out at sea and had a life jacket on, the life jacket wouldn't get you to shore; it would just keep you afloat. Medication is similar. It helps to keep you afloat while you do all the work of getting yourself to shore.
If I take medication, doesn't it mean I wasn't strong enough to do it on my own?
Absolutely not! A lot of us have, or know people who have, harsh judgments about mental health medications. We like to remind people that the medications we prescribe help to rebalance neurotransmitters. In the same way that we wouldn't judge someone for taking an antibiotic if they have a bacterial infection (it would seem a little ridiculous to judge someone for not being able to WILL a bacteria out of their body), we don't judge someone for not being able to WILL a neurotransmitter back into balance.
If I take a medication now, does that mean I have to take it for the rest of my life?
No—many people take medication for a period of time. Then, later on, they no longer need it. Other people may need medication on a longer-term basis. You and your prescriber can always discuss what your treatment plan will look like, and if you are ever uncomfortable with the medication you are taking, your provider can help you safely stop it.
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