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NEDA TOOLKIT for Parents Treatments available for eating disorders Standard treatments include medications (prescription drugs), various psychotherapies, nutrition therapy, other nondrug therapies, and supportive or adjunct interventions such as yoga, art, massage, and movement therapy. Some novel treatments are currently under research, such as implantation of a device called a vagus nerve stimulator implanted at the base of the neck. This stimulator is currently in use to treat some forms of depression, and it is under research for treating obesity. The most commonly used treatments—psychotherapy and medication—are delivered at various levels of inpatient and outpatient care, and in various settings depending on the severity of the illness and the treatment plan that has been developed for a particular patient. Bulimia nervosa and binge eating disorders can often be treated on an outpatient basis, although more severe cases may require inpatient or residential treatment. The levels of care and types of treatment centers are discussed in separate documents in the tool kit. The treatment plan should be developed by a multidisciplinary team in consultation with the patient, and family members as deemed appropriate by the patient and his/her team. Medication Biochemical abnormalities in the brain and body have been associated with eating disorders. Many types of prescription drugs have been used in treatment of eating disorders; however, only one prescription drug (fluoxetine) actually has a labeled indication for one eating disorder, bulimia nervosa. (This means that the manufacturer requested permission from the U.S. Food and Drug Administration (FDA) to market the drug specifically for treatment of bulimia nervosa and that FDA approved this request based on the evidence the manufacturer provided about the drug’s efficacy for bulimia nervosa.) Most prescription drug therapy used for treatment of the disorder is aimed at alleviating major depression, anxiety, or obsessive-compulsive disorder (OCD), which often coexist with an eating disorder. Some prescription drug therapies are intended to make individuals feel full to try to prevent binge eating. Generic and brand names of prescription drugs that have been used to treat eating disorders are listed in the chart. Some of these antidepressants also can exert other effects. Selective serotonin reuptake inhibitors alleviate depression, but may also play a role in making an individual feel full and possibly prevent binge eating in patients with bulimia or binge eating disorder. FDA has issued a warning and labeling to prevent prescription of one particular antidepressant for eating disorders Wellbutrin, which is available in several brand and generic formulations— because it leads to higher risk of epileptic seizures in these patients. Psychological Therapy Several types of psychotherapy are used in individual and group settings and with families. Patients must be medically stable to be able to participate meaningfully in any type of psychological therapy. Thus, a patient who has required hospitalization for refeeding and to stabilize his/her medical condition will ordinarily not be able to participate in therapy until after he/she has recovered sufficiently to enable cognitive function to return to normal. A given psychologist or psychiatrist may use several different approaches tailored to the situation. The types of psychotherapy used are listed here in a chart and defined below. Cognitive behavior therapy (CBT) and behavior therapy (BT) have been used for many years as first-line treatment, and they are the most- used types of psychotherapy for bulimia. CBT involves three overlapping phases. The first phase focuses on helping people to resist the urge to engage in the cycle of behavior by educating them about the dangers. The second phase introduces procedures to reduce dietary restraint and increase eating regularity. The last phase involves teaching people relapse-prevention strategies to help prepare them for possible setbacks. A course of individual CBT for bulimia nervosa usually involves 16- to 20-hour-long sessions over a period of 4 to 5 months. BT uses principles of learning to increase the frequency of desired behavior and decrease the frequency of problem behavior. When used to treat bulimia nervosa, BT focuses on teaching relaxation techniques and coping strategies that individuals can use instead of binge eating and purging or excessive exercise or fasting. Self-help groups are listed here because they may be the only option available to people who have no insurance. However, self-help groups can also have negative effects on a person with an eating disorder if they are not well-moderated by a trained professional. Page | 24