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Medications for treatment of bulimia nervosa MEDICATIONS FOR TREATMENT OF BULIMIA NERVOSA
Fenfluramine: This product also enhances serotonin activity and is widely used to promote weight loss in obese people. Recently a study found that fenfluramine may significantly reduce symptoms of both bulimia and depression.
Opiate antagonists: Certain drugs can block these endogenous opiates and thus reduce their effect on behavior. One of these products, naltrexone, is used to treat heroin addicts. Theory has it that naltrexone may also have a role in managing eating disorders. However, clinical results so far are mixed. One study turned up no evidence that naltrexone led to weight loss in obese people. And a study at the usual dosage level failed to show any impact on bingeing behavior, although a study at a dosage four times as high saw a significant reduction in bulimic symptoms. Unfortunately, such high doses also resulted in a high rate of nausea and a serious risk of liver toxicity.
Anticonvulsant drugs: In some ways, bulimia resembles a seizure disorder such as epilepsy. Seizure disorders involve misfires in the electrical system of the brain. Like seizures, bulimic binges are episodic - that is, they occur at unpredictable intervals rather than constantly. Both binges and seizures make their victims feel out of control. Many bulimics look on their binges as repugnant or inconsistent with their true personality-in other words, they feel their binges are somehow foreign, not really a part of themselves. People with seizures often make similar remarks.
To find out whether eating binges were the result of faulty brain wiring, some researchers studied the electroencephalograph readings of bulimic patients. Because they found brain waves similar to those seen in epilepsy, these researchers tried giving their patients phenytoin, an anti-seizure medication (sold under the brand name Dilantin). They reported that the drug was effective. Unfortunately, subsequent studies, failing to replicate these findings, indicated no more than mild results with phenytoin.
Another study looked at carbamazepine (sold under the brand name Tegretol), an anticonvulsant related to the TCAs that is used to treat seizure disorders and manic depression. Results showed that carbamazepine had a profound effect on a bulimic woman who also suffered from a mood disorder that resembled manic depression, but had no effect on five other patients in the study.
Thus the notion that bulimia is primarily a form of seizure disorder, and that anti-seizure medications can help, hasn't won many supporters over the last twenty years or so.
Anti-anxiety medications: Anxiety can set the binge-purge cycle in motion. Because therapy must address the patient's anxiety, naturally it's tempting to consider using one of the many anti-anxiety drugs on the market.
Perhaps the most widely known of these are the benzodiazepines such as diazepam (sold under the brand name Valium). We used to call these "minor tranquilizers" because they seemed relatively safe compared to the "major tranquilizers," such as chlorpromazine.
We now realize there's nothing "minor" about them. These powerful medications have a high potential for abuse and can lead to dependency. In the state of New York, for example, the law now requires that doctors follow the same procedures in prescribing benzodiazepines as they do when prescribing narcotics, another class of drugs with high potential for abuse. As we have seen, bulimics have a high incidence of substance abuse, and may misuse an anti-anxiety drug. Side effects include drowsiness, disorientation, and headaches.
Anti-anxiety medicines do have a specific use, however. I may prescribe them for a limited time when a patient knows she is about to face a highly stressful situation, such as a family reunion or a trip home for Thanksgiving.
Stimulant medications: Although amphetamines may help reduce appetite and produce antidepressant effects, these drugs have a high potential for abuse and are almost never appropriate for use by bulimics.
Lithium carbonate: Some physicians have given lithium, commonly used in treating bipolar disorders, to bulimics. A few of those treated, including some who didn't respond to other antidepressants, noticed a drop in their bingeing and purging episodes. We don't yet have good controlled studies proving the effectiveness of this medication. Lithium has a serious drawback: It depletes the body's supply of potassium. As we have seen, bulimics who vomit a lot or who abuse laxatives or diuretics are already at risk of low potassium. The medical literature contains at least one report of a bulimic woman who died of cardiac failure caused by the combined effects of vomiting and lithium.
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