Eating Disorders: Anorexia and Bulimia

Description

Alternative Names

Treatment for Bulimia

Some experts recommend a stepped approach for patients with bulimia, which may follow these stages, depending on the severity and response to initial treatments:

• Support groups. This is the least expensive approach and may be helpful for patients who have mild conditions with no health consequences.
• Cognitive-behavioral therapy (CBT) along with nutritional therapy is the preferred first treatment for bulimia that does not respond to support groups.
• Drugs. The drugs used for bulimia are typically antidepressants known as selective serotonin-reuptake inhibitors (SSRIs). A combination of CBT and SSRIs is very effective if CBT is not helpful.

Patients with bulimia rarely need hospitalization except under the following circumstances:

• Binge-purge cycles have led to anorexia.
• Drugs are needed for withdrawal from purging.
• Major depression is present.

Psychotherapeutic Approaches and Medications for Bulimia

Psychologic Therapy. Cognitive-behavioral therapy (CBT) is the first-line of therapy for most patients with bulimia and is successful in about 60% of cases. In one study of bulimic patients those who did not respond to CBT tended to be less committed to the treatment, were more preoccupied with their symptoms, and had ritualized eating behaviors. Interpersonal therapy may be tried if CBT fails, although in one study it was no more successful than antidepressants.

Antidepressants. Because of the high incidence of depression in patients with bulimia, antidepressant medication is often recommended for patients who have normal weight or for those who are overweight. They should be used in combination with CBT. (These agents can cause weight loss and should not be used in patients who are underweight, unless it is part of a clinical trial.) The most common antidepressants prescribed for bulimia are selective serotonin reuptake inhibitors (SSRIs). They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and fluvoxamine (Luvox). Studies are mixed, however, on whether SSRIs offer an additional advantage in reducing binge-eating compared to CBT. Prozac has been approved for bulimia and is considered the drug of choice, although some studies suggest that other SSRIs, such as Luvox, may be even more effective.

If the drugs are not effective, the physician should be sure it is not because the patient is vomiting after taking the medication. Some experts believe that these agents should be continued even after symptoms have improved in order to restore healthy brain chemical balances.

Drug Therapy for Bulimia Nervosa

Agents to Prevent Vomiting. In one study, ondansetron, a drug that prevents vomiting, reduced the binge-purge episodes by half. The drug may cause depression in people already on SSRI antidepressants. More studies are needed.

Sibutramine. Sibutramine (Meridia) is a drug used for weight loss. It does so by keeping two important brain chemicals, serotonin and norepinephrine, in balance, which helps to increase metabolism. Some evidence suggests that the actions of this drug may be useful for people who binge. Note, however, that for bulimic patients this agent should be used only for those with normal or above normal weight and never for those who are anorexic.

Inositol. Inositol is a B vitamin that is being investigated for bipolar disorder, anxiety, and depression. A 2001 study suggests that it may also have benefits for bulimic patients.

Alternative Approaches to Bulimia

Hypnosis. A study on women with bulimia showed that they had a high susceptibility to hypnosis, suggesting that it might be beneficial as part of their treatment. People with anorexia, on the other hand, seem to be very resistant to the state of vulnerability required in this process.

Light Therapy. Some researchers have noted an association between bulimia and seasonal affective disorder (depression that intensifies in the darker winter months). This suggests that therapy using intense directed light may be useful. Studies report, however, that while light therapy relieves depression, it has little effect on binge-purging behavior. Some experts suggest it may be more useful in combination with medication and psychotherapy.

Guided Imagery. A technique called guided imagery reduced frequency of binges and vomiting by almost 75% in one study. This method uses audiotapes to evoke images that will reduce stress and help achieve specific goals.