How Do Antidepressants Treat Bulimia?

Antidepressants address brain chemical imbalances. While experts aren’t exactly sure how they help people with bulimia, research shows that many people struggling with bingeing and purging get better when they take their prescriptions regularly.

Antidepressants work best as part of a comprehensive treatment program for bulimia. Your medications may help you feel more comfortable participating in therapy.

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But it can take time to find the right medication and dose. Side effects are common in the early stages of treatment, and your doctor might need to work with you to help you stay comfortable.

doctor with pill bottle in hand

Why Do Antidepressants Help With Bulimia?

Some people with bulimia have depression. Antidepressant medications are clearly helpful for them. But the research suggests that even people who aren’t depressed can get bulimia help through medications.

Researchers aren’t sure how antidepressants help people with bulimia. They suspect some people have serotonin issues driving their bulimia behaviors, and since some antidepressants work on those pathways, they can help. But they’re not 100% sure.[1]

The imbalance of serotonin levels in the body can increase urges to binge and purge in women and men who have bulimia. Antidepressant medications may decrease these urges by effectively balancing the levels of neurotransmitters in the brain.

Studies show that antidepressants do help.

In one study of people taking Prozac for bulimia, the following was found:[2]

  • Binge eating episodes declined from 22 to 4 episodes per month.
  • Purging episodes declined from 30 to 6 episodes per month.

When researchers compared Prozac to a placebo, they found that the medication alone helped to reduce bingeing and purging episodes.[3]

While researchers may not understand the exact mechanism of action, it’s clear that antidepressants can help people with bulimia feel better.

What Antidepressants Can Doctors Use to Treat Bulimia?

The most common antidepressant medication studied and prescribed for the treatment of bulimia is fluoxetine, known by the brand name Prozac. But there are many different types of antidepressants your doctor could use.

Common antidepressants include the following:

  • Selective serotonin reuptake inhibitors (SSRIs): These are the most commonly prescribed antidepressant medications. They increase serotonin in the body.Drugs in this class include Celexa, Lexapro, Prozac, Paxil, and Zoloft.
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs): These antidepressant medications function by increasing the amount of serotonin and norepinephrine in the brain by blocking the reabsorption of those neurotransmitters.Trade brands of SNRIs include Effexor, Cymbalta, and Yentreve.
  • Tricyclic antidepressants: Among the earliest antidepressants compounded, these medications also function by making neurotransmitters more readily available in the brain, which in turn boosts mood.

Trade brands of these classes of medications include Norpramin, Tofranil, Pamelor, and Vivactil.

  • Monoamine oxidase inhibitors: These medications decrease the amount of monoamine oxidase, an enzyme that breaks down neurotransmitters. The effect of this helps improve depression symptoms.Brand name MOIs include Marplan, Laniazid, Aurorix, and Azilect.

Prozac is currently the only antidepressant medication approved by the Food and Drug Administration (FDA) for bulimia treatment, as it has been shown to decrease the frequency of binge eating and vomiting. But if it doesn’t work for you, other options exist.

Antidepressant Side Effects You Should Know About

Antidepressants, like all other medications, may produce negative side effects. As with all medications, it is necessary to remain under the supervision of a physician, who can monitor signs and symptoms that you may be experiencing as a result of your prescription.

Most side effects happen during the first few days of therapy and decrease with time.[4] Common side effects include the following:

  • Constipation
  • Drowsiness
  • Dry mouth
  • Fatigue
  • Insomnia
  • Loss of sex drive
  • Nausea

People with bulimia who take some medications often stop treatment early due to negative side effects. This issue is less common in people taking Prozac for bulimia.[5]

If your medications make you feel ill, don’t stop taking them without talking to your doctor first.

Psychological

How to Use Prozac for Bulimia

Your doctor will tell you how to take your medication, and your pill bottle will be clearly marked with dosage information.

Typically, you’ll take your medication for a week or two before you feel a change.[6] Don’t quit taking your prescription because you don’t notice a reduction in your bulimia symptoms. Your body needs time to adjust.

In some individuals, finding the correct antidepressant and dosage may take a trial phase. Your doctor may need to adjust your prescription before finding a protocol that works best for you.

What if Antidepressants Don’t Help Your Bulimia?

While antidepressants can be a helpful part of treatment, these medications are much more effective for bulimia when coupled with psychotherapy, such as cognitive behavioral therapy.

It is important to remember that since bulimia is a complex psychiatric illness, treatment must address various concerns on multiple levels: the physical/biological, emotional, and psychological.

Achieving total and complete healing involves work with a multidisciplinary team, which can be one of the greatest tools for treatment and recovery.

If you or someone you love is considering the use of antidepressant medication to treat bulimia, it is important to thoroughly discuss this option with your physician.

References

  1. Bulimia Nervosa in Adults: Pharmacotherapy. UpToDate. https://www.uptodate.com/contents/bulimia-nervosa-in-adults-pharmacotherapy. June 2022. Accessed July 2022.
  2. Fluoxetine for Bulimia Nervosa Following Poor Response to Psychotherapy. The American Journal of Psychiatry. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.157.8.1332. August 2000. Accessed July 2022.
  3. Fluoxetine in the Treatment of Bulimia Nervosa. A Multicenter, Placebo-Controlled, Double-Blind Trial. Fluoxetine Bulimia Nervosa Collaborative Study Group. Archives of General Psychiatry. https://pubmed.ncbi.nlm.nih.gov/1550466/. February 2022. Accessed July 2022.
  4. How to Safely Take Antidepressants. American Academy of Family Physicians. https://familydoctor.org/how-to-safely-take-antidepressants/. April 2020. Accessed July 2022.
  5. Pediatric Bulimia Medication. Medscape. https://emedicine.medscape.com/article/913721-medication. February 2020. Accessed July 2022.
  6. Overview: Antidepressants. National Health Service. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/overview/. November 2021. Accessed July 2022.

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