Pharmacological Treatment and Eating Disorders

Patients with eating disorders may receive pharmacological treatment for their eating disorders, their psychiatric comorbidities, and the physical health consequences of their disorder. The serotonin reuptake inhibitor fluoxetine is approved for the treatment of bulimia nervosa, and the stimulant lisdexamfetamine has approval for binge-eating disorder in some countries. Promising study results have been reported for the antipsychotic olanzapine and the cannabinoid receptor agonist dronabinol in anorexia nervosa and the antiepileptic drug topiramate in bulimia nervosa and binge-eating disorder. Further novel pharmacological approaches include the leptin analog metreleptin, the psychedelic psilocybin, and the atypical psychedelic (es-)ketamine for anorexia nervosa; and the combination of the adrenergic agonist phentermine with topiramate for bulimia nervosa and binge-eating disorder. When treating psychiatric comorbidities, the type of eating disorder should be considered. The antidepressant bupropion, for example, is contraindicated in anorexia nervosa and bulimia nervosa, because it might lead to weight loss and further increase the risk of seizures in these patients. Physical health consequences of eating disorders, which might also need pharmacological treatment, affect the gastrointestinal tract, the endocrine and metabolic system, the cardiovascular system, the bones, and the skin.