Antidepressant Medicines for Eating Disorders
Antidepressants that are most commonly used to reduce the binge-purge cycle associated with bulimia are:
- Fluoxetine (such as Prozac), which is a selective serotonin reuptake inhibitor (SSRI). Fluoxetine (such as Prozac) reduces binge-purge cycles in bulimia.3Other SSRIs have not yet been proven to be effective for bulimia.
- Tricyclics, such as imipramine (Tofranil, for example), amitriptyline, and desipramine (Norpramin, for example).
Antidepressants regulate brain chemicals that control mood. Guilt, anxiety, and depression about binging usually lead to purging. Antidepressants help keep emotions stable and can help reduce the frequency of binge-purge cycles.4
It may take several weeks for antidepressants to relieve symptoms associated with binge eating disorder, although they may become effective sooner. You may need to continue taking antidepressants over a long period of time to prevent a relapse.1
- Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac, for example) or fluvoxamine (Luvox).
- Tricyclics, such as imipramine (Tofranil) or desipramine (Norpramin).
- Atypical antidepressants such as bupropion (Wellbutrin, for example) or trazodone.
Antidepressants regulate brain chemicals that control mood. They can help reduce the compulsive behavior that leads to binging. These drugs can also help people who have both depression and binge eating disorder.
Antidepressant side effects
Antidepressants may produce some side effects. But side effects may be reduced or may go away after several weeks of treatment.
Before starting an antidepressant, tell your doctor about every medicine or supplement (prescription or nonprescription) that you are taking. Some antidepressants can have serious interactions with other medicines or dietary supplements.
Selective serotonin reuptake inhibitors (SSRIs)
Studies show that SSRIs may be less bothersome than other antidepressants, such as tricyclics. SSRIs have less serious side effects and are less dangerous in case of an overdose. Although side effects of SSRIs are usually mild, they can include nausea, loss of appetite, diarrhea, anxiety, irritability, problems sleeping or drowsiness, loss of sexual desire or ability, headaches, dizziness, and dry mouth. After several weeks of treatment, SSRI side effects may be less or may go away completely.
Tricyclic side effects can include stomach upset, constipation, dry mouth, blurred vision, and drowsiness. Some people gain weight and have problems with sexual desire and ability. Tricyclics are started in low doses and gradually increased to avoid overdose and other serious side effects.
Be sure to tell your doctor about all the medicines and herbal preparations you are currently taking. Tricyclic antidepressants can have serious interactions with other medicines, including those used to treat seizures, such as phenytoin (Dilantin, for example), or certain heart medicines, such as digoxin (for example, Lanoxin).
Bupropion and trazodone have different side effects than tricyclic antidepressants. They have side effects similar to those of SSRIs and may have additional side effects.
Possible side effects of bupropion include weight loss, agitation, confusion, nervousness, and anxiety. In rare cases, bupropion can cause other serious side effects, such as allergic reactions, heart palpitations, and seizures.
Possible side effects of trazodone include drowsiness, dizziness or lightheadedness, blurred vision, weight gain, dry mouth, constipation, headache, and nausea.
What to think about
You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.
Studies have found daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Talk to your doctor about this risk before taking an SSRI.
SSRIs make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.7
People who purge after they take antidepressants may not get enough of the medicine into their blood. Doctors may recommend that they take antidepressant medicine at bedtime after they have stopped purging. People who purge often need to have their blood checked regularly to measure the amount of medicine in their bloodstream.
- Steering Committee on Practice Guidelines, American Psychiatric Association (2006). Treating Eating Disorders: A Quick Reference Guide. Arlington, VA: American Psychiatric Publishing.
- Bacaltchuk J, et al. (2001). Antidepressants versus psychological treatments and their combination for bulimia nervosa. Cochrane Database of Systematic Reviews (4).
- Hay PJ (2010). Bulimia nervosa, search date January 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Sigel EJ (2011). Eating disorders. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp. 159–170. New York: McGraw-Hill.
- Yager J, et al. (2006). Practice Guideline for the Treatment of Patients With Eating Disorders, 3rd ed. Arlington, VA: American Psychiatric Association. Also available online: http://www.psychiatryonline.com/pracGuide/PracticePDFs/EatingDisorders3ePG_04-28-06.pdf.
- Carter WP, et al. (2003). Pharmacologic treatment of binge eating disorder. International Journal of Eating Disorders, 34(Suppl): S74–S88.
- Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795–803.
Last Revised: August 25, 2011
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