The use of pharmaceutical drugs in the treatment of eating disorders
Parents often struggle with decisions around the use of drugs in the treatment of eating disorders.
Malnourishment, by itself, has severe psychological effects on cognition and behavior. Malnutrition also changes the effect of medicines on the body and thinking.
In addition, patients often also suffer from thought and mood disorders, which may include depression, obsessive-compulsive disorder, sleep disturbance and symptoms consistent with personality disorders. These disorders may preexist, or be exacerbated by low or erratic nutrition. In some cases, thought and mood disorders may be masked by the neurobiology of an eating disorder - as an eating disorder can be a form of self-medication for anxiety, depression, and attentional problems.
Generally, the psychological problems of sufferers are symptoms of the disease, not causal. Growing evidence suggests most of these symptoms diminish over time as patients reach and sustain optimum weight for their genetic makeup.
It is very important, when discussing drug treatments, that the clinician be trained and experienced in eating disorder symptoms, thinking, and physiology. Parents need to communicate openly and clearly about patient symptoms, compliance, and possible side-effects on an ongoing basis. Drug effects are highly variable between patients, and at different stages of recovery.
Antidepressants
Often clinicians advise parents to consider antidepressant therapy to aid in their child’s recovery.
“Drug treatments, such as SSRI or other antidepressant medication, have not been found to be generally effective for either treating anorexia, or preventing relapse… It is common, however, for antidepressants to be prescribed, often with the intent of trying to treat the associated anxiety and depression."
The use of antidepressant therapy for children and adolescents has received heightened scrutiny, in the wake of studies suggesting an increased incidence of suicidal thinking among young patients receiving these drugs. Below is a list of weblinks parents can review as they weigh this treatment option. All parents should feel comfortable seeking a second opinion if a clinician recommends antidepressant medication, and they have concerns.
Whenever a child/adolescent is taking these medications, they should not be withdrawn without the careful oversight of a physician.
Articles of interest:
The Effects Of Starvation On Behavior: Implications for Eating Disorders by David M. Garner, Ph.D
Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers
Medication management of pediatric eating disorders
Antidepressants in short-term treatment of binge eating disorder: systematic review and meta analysis
Medline Drug Information
Antidepressants: Update on New Agents and Indications
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