From the Guidelines
The most effective medication for treating eating disorders, specifically bulimia nervosa and binge eating disorder, is fluoxetine (Prozac) at a dose of 60mg daily, as recommended by the American Psychiatric Association (1). When considering treatment for eating disorders, it's crucial to differentiate between the various conditions, including bulimia nervosa, binge eating disorder, and anorexia nervosa.
- For bulimia nervosa, the American Psychiatric Association recommends treating adults with eating disorder-focused cognitive-behavioral therapy and prescribing a serotonin reuptake inhibitor, such as 60 mg fluoxetine daily, either initially or if there is minimal or no response to psychotherapy alone by 6 weeks of treatment (1).
- For binge-eating disorder, patients can be treated with eating disorder-focused cognitive-behavioral therapy or interpersonal therapy, in either individual or group settings (1).
- Anorexia nervosa, however, does not have a single medication proven to be highly effective, but olanzapine may help with weight gain and anxiety in some patients, although this is not explicitly recommended by the APA guideline (1). It's essential to note that medication should always be part of a comprehensive treatment approach, including psychotherapy, nutritional counseling, and medical monitoring, as emphasized by the APA (1). Key aspects of treatment include:
- Addressing underlying issues like depression, anxiety, or obsessive thoughts that often accompany eating disorders
- Monitoring side effects closely, especially in malnourished patients who may be more sensitive to medications
- Regular follow-up with healthcare providers to adjust treatment as needed and monitor for complications (1).
From the FDA Drug Label
The recommended dose is 60 mg/day, administered in the morning. For some patients it may be advisable to titrate up to this target dose over several days. Fluoxetine doses above 60 mg/day have not been systematically studied in patients with bulimia Prozac is indicated for the treatment of binge–eating and vomiting behaviors in patients with moderate to severe bulimia nervosa The efficacy of Prozac 60 mg/day in maintaining a response, in patients with bulimia who responded during an 8–week acute treatment phase while taking Prozac 60 mg/day and were then observed for relapse during a period of up to 52 weeks, was demonstrated in a placebo–controlled trial
The best medication for treating bulimia nervosa is fluoxetine (PO) at a dose of 60 mg/day.
- Key points:
- The dose should be administered in the morning.
- For some patients, it may be advisable to titrate up to the target dose over several days.
- Doses above 60 mg/day have not been systematically studied in patients with bulimia.
- Indication: Fluoxetine is indicated for the treatment of binge-eating and vomiting behaviors in patients with moderate to severe bulimia nervosa.
- Maintenance treatment: The efficacy of fluoxetine 60 mg/day in maintaining a response in patients with bulimia has been demonstrated in a placebo-controlled trial for up to 52 weeks 2. However, there is no information about the best medication for anorexia nervosa or binge eating disorder in the provided drug labels. Additionally, fluoxetine may be considered for other conditions, but the provided drug labels do not support its use as the best medication for eating disorders in general, except for bulimia nervosa 2.
From the Research
Medications for Eating Disorders
The following medications are used to treat eating disorders:
- Fluoxetine for bulimia nervosa 3, 4, 5, 6, 7
- Lisdexamfetamine for binge eating disorder 4, 7
- Olanzapine for anorexia nervosa, although not as a stand-alone treatment 4, 5, 7
- Selective serotonin reuptake inhibitors (SSRIs) for comorbid unipolar depression 4, 5
- Topiramate as a potential future option for bulimia nervosa and binge eating disorder 4
Comparison of Medications
A study comparing fluoxetine and citalopram for the treatment of bulimia nervosa found that both medications showed significant improvement in eating psychopathology, but with different efficacy profiles 6. Another study found that fluoxetine was effective in reducing vomiting and binge-eating episodes in patients with bulimia nervosa 3.
Treatment Approaches
Pharmacological treatment of eating disorders often includes medications to treat comorbid mental health problems, malnutrition, and physical health consequences 4. An interdisciplinary treatment approach, shared decision making, and the formulation of common treatment goals by patients, their family or carers, and clinicians can improve treatment success and safety 4.
Future Directions
Novel genetic, immunological, microbiome, and brain imaging research, as well as new pharmacological developments, may extend therapeutic options for eating disorders in the near future 4.