Pharmacotherapy

Pharmacotherapy (Anorexia Nervosa) - Thin Ice Tactics

• No FDA-approved drugs for core AN symptoms; primarily treat comorbidities.
• SSRIs (e.g., Fluoxetine):
  • For comorbid depression/anxiety, after some weight restoration.
  • ⚠️ Caution if severely underweight: cardiac risks, potential weight ↓.
• Atypical Antipsychotics (e.g., Olanzapine):
  • Off-label use for modest weight gain (e.g., 2.5-5 mg/day).
  • May ↓ anxiety, obsessionality.

⭐ Olanzapine may be used off-label in Anorexia Nervosa for promoting weight gain and reducing anxiety or obsessional thoughts, though no medication is FDA-approved for core AN symptoms.

Pharmacotherapy (Bulimia Nervosa) - Binge Halt!

• SSRIs: First-line treatment.
  • Fluoxetine: Only FDA-approved drug.
    • Dose: 60 mg/day (higher than for depression).
    • Mechanism: Reduces binge-purge frequency.
  • Other SSRIs (e.g., sertraline, citalopram, escitalopram): May be used off-label.
• Topiramate:
  • Reduces bingeing and purging episodes.
  • Associated with weight loss.
  • ⚠️ Side effects: Cognitive (e.g., word-finding difficulties, paresthesias).
• Contraindicated Medications:
  • Bupropion: ⚠️ Contraindicated due to ↑ seizure risk in patients who purge.
• Limited Role:
  • TCAs & MAOIs: Generally not preferred due to side effects and dietary restrictions (MAOIs).

⭐ Fluoxetine is the only FDA-approved medication for Bulimia Nervosa, typically at a higher dose (60 mg/day) than used for depression.

Pharmacotherapy (Binge Eating Disorder) - Feast Control

• SSRIs (e.g., Fluoxetine, Sertraline):
  • Moderate efficacy in ↓ binge frequency.
  • Addresses comorbid depression/anxiety.
  • Often first-line due to tolerability.
• Lisdexamfetamine (Vyvanse):
  • Stimulant, prodrug of dextroamphetamine.
  • Reduces binge days/episodes.
  • Monitor for cardiovascular & psychiatric side effects.

  ⭐ Lisdexamfetamine (Vyvanse) is FDA-approved for treating moderate to severe Binge Eating Disorder in adults and can reduce binge frequency.

• Anticonvulsants:
  • Topiramate: ↓ binge frequency, promotes weight loss. Side effects: cognitive (e.g., word-finding difficulty), paresthesias. ⚠️ Risk of kidney stones, metabolic acidosis.
  • Zonisamide: Similar to topiramate; less studied for BED.
• Naltrexone/Bupropion Combination:
  • May be considered, especially with co-occurring obesity.
  • Naltrexone (opioid antagonist) + Bupropion (NDRI).

Pharmacotherapy (Key Drugs Summary) - Pills & Alerts

⭐ Bupropion is contraindicated in patients with a current or prior diagnosis of Bulimia Nervosa or Anorexia Nervosa due to an increased risk of seizures.

High‑Yield Points - ⚡ Biggest Takeaways

• SSRIs (Fluoxetine) are first-line for Bulimia Nervosa (BN) & Binge Eating Disorder (BED).
• Fluoxetine (60mg) is FDA-approved for BN; higher dose than depression.
• Limited drug role in Anorexia Nervosa (AN) for weight gain; treat comorbidities.
• Olanzapine may aid weight gain in AN (off-label).
• Lisdexamfetamine is FDA-approved for moderate-severe BED.
• Avoid Bupropion in BN/AN (↑ seizure risk).
• Topiramate (off-label for BN/BED) can cause weight loss; monitor cognition_._