Medication for eating disorders is an option that is sometimes suggested when you seek help. However, you may wonder which approach is best – psychological therapy, drugs, or both? You may have some fears about medications used in treating mental health problems. Some people see them as something that contaminates them, they fear addiction, or fear withdrawal.
It’s normal to have fears, and it’s important to feel like you are making the best and most informed choices for your mental health. That’s why it’s vital that you get the right advice and support. It’s always about collaboration with you as the client, rather than us as health professionals simply telling you what you should do.
Here at Altum Health, we have Consultant Psychiatrists on our team to help assess clients and give advice if they are interested in trying medication. Dr Yoav Jacob is one of our Consultants. In this blog interview, we talk about the benefits of medication in the treatment of mental health issues, and specifically, the types of medications commonly used in eating disorders.
Would you advise using medication to treat eating disorders?
The answer to this question is ‘sometimes yes and sometimes no’. Primarily what guides my decision to offer medication is the level of distress someone is feeling and the psychological approaches that have been tried before.
As a general rule, therapy is usually a good start. Ultimately, clients have to learn to deal with their emotions and to learn to regulate them, so while medication can often reduce some symptoms, risks and impulses, it cannot teach them these vital skills the way that therapy can.
That said, going through therapy can be a very difficult process and sometimes people’s moods can initially deteriorate. It’s then that medication can also be helpful in supporting people through these difficult periods.
Medication can sometimes help lessen someone’s level of distress so that they are able to access the benefits of therapeutic treatment fully. If someone is profoundly depressed and they are so low that using therapy can be difficult, then using medication alongside it can actually help support them to have the energy and the motivation to use what therapy can offer.
Courtney has a great metaphor about using medication that I like to use. Imagine being at the bottom of a huge mountain. At the top of the mountain, you stand with your therapist and look out into the distance and see a beautiful city. This is where you want to go. There are many ways to get there, and you and your therapist can decide, together, which ones to take. But sometimes, you are so distressed and overwhelmed, that you can’t even get up the mountain to see the way through to the city. You are stuck at the bottom and all you see is dirt and rock. Medication can help pave the path up the mountain to the top to see what’s possible.
What about people who are desperate to start medication – do you always say yes?
Medication is not suitable for everyone and sometimes it is our duty to say ‘no’. Sometimes, potential clients arrive and may be emotionally unstable. They request medication immediately. However, after a psychiatric assessment, a conclusion may be that starting with psychological therapy is a better option.
Then, there is another group of people we see who have tried many medications and in some ways see themselves as ‘experts’. They may have seen several Psychiatrists at various organisations and never, in their view, got ‘the right medication’. While considering different medications can be an option it is also worth thinking psychologically; medication doesn’t always have a role in treatment. It might be that finding the ‘magic tablet’ is not the answer.
What are the options when treating eating disorders with medication?
In Anorexia Nervosa, traditionally two medications are regularly prescribed – Olanzapine, an antipsychotic, and Fluoxetine, an antidepressant. These medications have been used for several decades and there is good evidence to show that they are effective.
Fluoxetine is an SSRI (Selective Serotonin Reuptake Inhibitor) antidepressant. It has relatively mild side effects, and it has a long half-life, staying in the system for longer. Because it’s so well known, it isn’t a medication that’s going to cause any surprise side effects for most people, so is a good place to start.
Olanzapine is a powerful antipsychotic drug, but it isn’t used primarily for its antipsychotic properties in Anorexia. It has a role as medication that can act as a tranquilliser and can calm people down, relax them and can help increase appetite. It’s also sedating without being addictive and can help with sleep and anxiety. We sometimes use other antipsychotics and antidepressants based on people’s individual tolerance and the medication’s clinical effectiveness in reducing distressing symptoms.
For Bulimia, the choice of medications is usually different. Sertraline (another SSRI antidepressant) is often used at a high dose to treat the compulsion to binge. This means that purging reduces and people can start tolerating eating normally, in a more regulated way.
How do you start taking a medication and how long should you be on it?
A trial of an antidepressant is traditionally for six weeks at an adequate dose. Most people will see a difference between two and six weeks. For some people it does take much, much longer though, so be aware of this when starting your trial. Antipsychotics usually work within the first four weeks.
If you are taking an antidepressant, I usually advise you carry on taking it for at least six months after feeling better and maybe two years if you’ve had previous episodes of depression.
Medication to treat eating disorders is always your choice.
We believe that the client should always have a choice. It’s our job to provide as much information as we can to educate your decision – what it feels like to take it, the upsides, the downsides, the potential side effects, the proposed course of action – then you have all you need to make an informed choice.
The one thing to remember is that it’s always reversible. If you don’t get on with a medication, let your Psychiatrist know. Drop them an email, ring, book a follow up appointment. Access other choices, change the medication, or the dose, or you can choose to stop in a safe way.
But don’t let your fear stop you from trying. Often getting medication right for you involves some trial and error – it can work straight away, but sometimes it can take time to find the right medication to treat an eating disorder that will work the best for you. It is worth getting this right even if it takes a little longer. Our aim is always to work with you to reduce distress and support you in changing your life for the better.