During the past few years of the 21st century, the possibility that antidepressants increase the risk of suicide in adolescents stirred considerable controversy and led to caution in prescribing these medications for this age group. Meanwhile, scientists analyzed extensive data about safety of antidepressants in young people and found the risk of suicidal thoughts and behavior to be much lower than anticipated. This is excellent news. If your child’s doctor prescribes an antidepressant, he or she will monitor her during the early phases of treatment and talk with you about the advantages and safety of the medication. By reducing anxiety and improving mood, an antidepressant may allow a patient with an eating disorder to better accept therapy and, at times, to use it more effectively.
Whereas antidepressant medication has been helpful to many individuals with bulimia, its role in the treatment of anorexia nervosa is less clear. Although SSRIs have not proven effective in promoting weight gain, they are commonly prescribed for individuals with anorexia nervosa; seem to be well tolerated; and often have a positive effect on mood, anxiety, and obsessive-compulsive tendencies (persistent, uninvited thoughts, and behaviors resulting from obsessions). SSRIs do not seem to prevent relapse in patients with anorexia who have just been discharged from the hospital after gaining weight.
Anita recalls how the sense of well-being that marked the earliest phase of her anorexia waned. “Food- and weight-related pressures started to bombard me from all sides; each guilt trip that I’d eaten something ‘fattening’ would prey on my mind until a new, similar worry would come along to take its place. Before meals and snacks, my fears would go through the roof. My primary care doctor prescribed a low dose of an SSRI for me and explained that it would not take effect for several weeks. For the interim, he suggested a low dose of Ativan [lorazepam], a short-acting sedative that would help ease my anxiety about taking in food.”
An individual with anorexia can benefit from a family of medications that originated as a treatment for schizophrenia and is now used to alleviate obsessions and compulsions, agitation, and idiosyncratic thoughts. The association of this group of antipsychotic drugs with weight gain sparked interest in their use in the treatment of anorexia patients who are entrenched in the illness and unable to see that they have a problem or need treatment. Zyprexa (olanzapine) and other medications in this class tend to improve an individual’s mistaken belief that she is obese or that one meal will make her fat. With this class of medications, ongoing medical monitoring is essential.
Don’t be surprised if your child is reluctant to take medication for her eating disorder. Whether she wants to recover herself (without meds) or fears that her medication will make her fat or control her thinking, it’s possible that she’ll refuse a prescription.
Many patients are opposed not just to trying medication but to any change. Some are unable to admit that they are ill or that medication is warranted and others worry about side effects such as constipation. Concerns such as these call for patience and understanding. Remind your child of the ways her eating disorder “gets in the way” by keeping her from sports or making her cold and tired; point out that medication can help her feel less down and thereby make it easier for her to work on her eating difficulties.