Bipolar Illness and Eating Disorders

Bipolar illness is a mood disorder that affects up to 4% of Americans. The illness is characterized by extreme mood swings from manic “highs” to depressive “lows.” Most individuals with bipolar spend much more time depressed than “high.”

Before there were effective treatments, the natural progression of the illness was a steady downward course with increasingly frequent and increasingly debilitating mood swings.

The state hospitals, when there were state hospitals, were populated with many of the long-term victims of this illness.

Bipolar Illness and The Association with Eating Disorders

We now have medications that can stabilize mood and prevent this downhill course. It has long been recognized that individuals with bipolar disorder are also prone to other disorders including drug and alcohol abuse.

Recently, researchers have been interested in whether there might be an association with eating disorders.

In fact, there is an association. Depending on the study, researchers have found that 5% to 14% of individuals with bipolar disorder also have an eating disorder diagnoses.

Binge Eating Disorder appears to be the most frequent co-occurring eating disorder, followed by Bulimia Nervosa and then Anorexia Nervosa. The combination of Bipolar and Eating Disorder may be more difficult to treat than Bipolar illness alone.

The Complications from This Dual Diagnosis

One of the complicating factors in treating the combined illnesses has to do with medication side effects. Two of the most effective medications for bipolar illness, lithium and valproic acid (Depakote) can be associated with weight gain.

Individuals with binge eating disorder are frequently overweight and adding lithium or valproic acid can result in additional weight gain. Normal weight individuals with bulimia and underweight individuals with anorexia are typically fearful of weight gain and may either refuse these medications outright or fail to follow through consistently.

Further, purging, which typically occurs with bulimia and can occur with anorexia also affect levels of the medication even when the medications are taken consistently.

There are alternative mood stabilizers like lamotrigene and carbamazepine that can be used and are less likely to result in weight gain, although they are possibly less effective.

The Problem with Antidepressants

Another consideration is that antidepressants, which are sometimes used to treat Bulimia and Binge Eating have the potential to accelerate mood swings, making bipolar worse.

If all this sounds complicated, it is. An important point to remember is that mood-stabilizing medication is essential to the control of bipolar illness. No amount of talking therapy will substitute.

When it comes to the medication management of bipolar illness in the presence of an eating disorder it is important to work with a psychiatrist who has knowledge of both and can safely navigate the best course toward recovery.

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Contributor: Michael Pertschuk, MD, Medical Director of the Eating Disorders Program at Brandywine Hospital

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on January 16th, 2015
Published on EatingDisorderHope.com