VINCENT SQUARE EATING DISORDER SERVICE

MEDICATION PRESCRIBED FOR BINGE EATING DISORDER: ADVICE FOR SERVICE USERS AND CARERS

The mainstay of treatment for binge eating disorder is some form of talking therapy. This is usually offered individually (CAT or CBT are offered at Vincent Square EDS) or sometimes with your family to support healthy eating patterns.

Prescribed medicines may be part of your care plan to treat your eating disorder. This leaflet describes the different medicines most commonly prescribed for binge eating disorder.

ANTIDEPRESSANTS

Antidepressants can be used to help reduce the frequency of bingeing. They can also help treat symptoms of depression which may occur at the same time as an eating disorder. The most common group of antidepressants prescribed are called selective serotonin reuptake inhibitors (SSRIs).

Antidepressants for Binge Eating: Taking an SSRI should help reduce the frequency of bingeing in the short term though the longer term effects are unknown. As with a talking therapy the SSRI helps you achieve more controlled eating and a stable weight rather than significant weight loss. Antidepressants on their own have not been shown to be as effective as some talking therapies such as CBT. They can be a useful first step, especially if there is a long wait to access a talking therapy. If you are already receiving a talking treatment such as CBT then there is unlikely to be an added benefit from starting an SSRI unless you are also depressed. Fluoxetine (Prozac) is the usual first choice. You may be offered a higher dose of SSRI than you would take for depression. E.g. 60mg of fluoxetine.

Antidepressants for Depression: If your depressive symptoms are severe, longstanding or associated with suicidal thoughts then your doctor may discuss taking an antidepressant. The most commonly used antidepressants are called selective serotonin reuptake inhibitors (SSRI). E.g. fluoxetine, citalopram or sertraline. Some other prescriptions such as venlafaxine and mirtazapine are sometimes used. They work in a slightly different way but do a similar job. However they have slightly different side effects and you should ask your doctor for an information leaflet.

Antidepressants usually take between two and six weeks to take full effect. It is recommended that you carry on taking them for at least six months after your mood recovers. If you have experienced two or more episodes of depression then you should consider taking them for two years or longer. You should usually reduce the dose gradually rather than stopping abruptly to avoid unwanted withdrawal symptoms.

Topiramate( Topamax): This is usually used to treat epilepsy or migraines. It has also been shown to help reduce the frequency of binges (but does not achieve significant weight loss without additional psychological support). This benefit has not yet been shown to last in the long term and the evidence is that talking therapies such as CBT have the best chance of successfully treating your eating disorder. However, you may consider it if you have a long wait for therapy.

If you are already receiving a talking therapy such as CBT you might consider adding in topiramate. If taken alongside talking therapy such as CBT it can help achieve modest weight loss even though it may not change your eating patterns beyond what you would achieve though therapy alone.

(It can interfere with other medicines such as the oral contraceptive pill.) You should only consider this if your body mass index (BMI) is over 30.

Orlistat (Xenical): This reduces the amount of calories that the body is able to absorb through fatty food. It has been shown to help people with binge eating disorder lose a modest amount of weight during CBT.

You can talk to your GP about being prescribed this. You may need to take it up to three times a day. It can also be bought over the counter in a pharmacy (Alli) and you should let your doctor know if you are using it. It should only be considered if your BMI is over 28. If you continue to overeat fatty foods while taking it you may experience unpleasant tummy upset and diarrhoea. You may also need to take vitamin supplements if you use it for a long time.

Other medications: Sibutramine (Reductil) and rimonabant (Acomplia) have both been withdrawn due to dangerous side effects and are no longer available.

Vincent Sq Clinic J Arkell 8/7/2010

Vincent Sq Clinic M Raikkonen 04/04/2013