NEDA TOOLKIT for Parents
Several different antidepressants may have to be tried
sequentially to identify the specific medication with
the optimum effect [I].
Clinicians should attend to the black box warnings
relating to antidepressants and discuss the potential
benefits and risks of antidepressant treatment with
patients and families if such medications are to be
prescribed [I].
Small controlled trials have demonstrated the efficacy
of the anticonvulsant medication topiramate, but
because adverse reactions to this medication are
common, it should be used only when other
medications have proven ineffective [III]. Also, because
patients tend to lose weight on topiramate, its use is
problematic for normal or underweight individuals
[III]. Two drugs that are used for mood stabilization,
lithium and valproic acid, are both prone to induce
weight gain in patients [I] and may be less acceptable
to patients who are weight preoccupied. However,
lithium is not recommended for patients with bulimia
nervosa because it is ineffective [I]. In patients with co-
occurring bulimia nervosa and bipolar disorder,
treatment with lithium is more likely to be associated
with toxicity [I].
iii. Combining Psychosocial Interventions and
Medications In some research, the combination of antidepressant
therapy and CBT results in the highest remission rates;
therefore, this combination is recommended initially
when qualified CBT therapists are available
[II]. In addition, when CBT alone does not result in a
substantial reduction in symptoms after 10 sessions, it
is recommended that fluoxetine be added [II].
iv. Other Treatments
Bright light therapy has been shown to reduce binge
frequency in several controlled trials and may be used
as an adjunct when CBT and antidepressant therapy
have not been effective in reducing bingeing
symptoms[III]. 5.
Eating Disorder Not Otherwise Specified
Patients with subsyndromal anorexia nervosa or
bulimia nervosa who meet most but not all of the
DSM-IV-TR criteria (e.g., weight >85% of expected
weight, binge and purge frequency less than twice per
week) merit treatment similar to that of patients who
fulfill all criteria for these diagnoses [II].
a. Binge Eating Disorder
i. ii.
Nutritional Rehabilitation and Counseling
Maintenance Phase
Limited evidence supports the use of fluoxetine for
relapse prevention [II], but substantial rates of relapse
occur even with treatment. In the absence of adequate
data, most clinicians recommend continuing
antidepressant therapy for a minimum of 9 months
and probably for a year in most patients with bulimia
nervosa [II]. Case reports indicate that
methylphenidate may be helpful for bulimia nervosa
patients with concurrent attention-
deficit/hyperactivity disorder (ADHD) [III], but it should
be used only for patients who have a very clear
diagnosis of ADHD [I].
Behavioral weight control programs incorporating
low- or very-low-calorie diets may help with weight
loss and usually with reduction of symptoms of binge
eating [I]. It is important to advise patients that weight
loss is often not maintained and that binge eating may
recur when weight is gained [I]. It is also important to
advise them that weight gain after weight loss may be
accompanied by a return of binge eating patterns [I].
Various combinations of diets, behavior therapies,
interpersonal therapies, psychodynamic
psychotherapies, non-weight-directed psychosocial
treatments, and even some “non-diet/health at every
size” psychotherapy approaches may be of benefit for
binge eating and weight loss or stabilization [III].
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