Tuesday, December 6, 2022

Can Antidepressants Cause Eating Disorders

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No Evidence Of Brain Disorder

Prozac hit the market in 1987, followed by Zoloft in 1991 and Paxil in 1992. All are designed and marketed as a scientifically sound method of reducing depression by increasing serotonin levels in the brain. This idea is based on the assumption that a chemical imbalance causes depression, however, there is no evidence of a biological brain disorder that causes depression.

  • There is no correlation between serotonin levels and depression
  • Elevations or decrements in the functioning of serotonergic systems per se, are not likely to be associated with depression.
  • There is no scientific evidence whatsoever that clinical depression is due to any kind of biological deficit state.
  • In every instance where such an imbalance was thought to be found, it was later proved to be false.
  • We have hunted for big simple neurochemical explanations for psychiatric disorders and have not found them.

Ssri Antidepressant Discontinuation Symptoms

Symptoms that may occur on suddenly stopping an SSRI include dizziness, loss of coordination, fatigue, tingling, burning, blurred vision, insomnia, and vivid dreams. Less often, there may be nausea or diarrhea, flu-like symptoms, irritability, anxiety, and crying spells. “Discontinuation syndrome” is a better description than “withdrawal reaction,” a phrase associated with addiction. The syndrome is usually mild, but can be severe.

Although none of these types of antidepressants should be stopped abruptly, paroxetine tends to produce the most intense discontinuation symptoms. Here is a place where the longer-lasting drugs have an advantage; some clinicians switch to fluoxetine before gradually lowering the dose.

A Management Of Clinical Problem Eating Disorders

Hospitalization criteria
  • Severe malnutrition <75% average body weight for age, sex and height

  • Physiologic instability, i.e.:

    orthostatic hypotension â pulse increase of 20 bpm or systolic blood pressure drop of >10 mmHg

    hypotension <80/50 mmHg

    bradycardia <40 bpm

    tachycardia >110 bpm

    hypothermia <97 F

  • Significant electrolyte disturbances â e.g., potassium <3 mEq/L

  • Failed outpatient therapy

  • Acute medical complications of malnutrition â e.g., syncope, cardiac, renal

  • Acute psychiatric emergencies â e.g., suicidal ideation, acute psychosis

Most of the medical complications improve and resolve with refeeding, weight gain and cessation of purging.

Nutrition

On admission, daily caloric intake usually begins at 30â40 kcal/kg/day or adding 200â300 kcal to the individualâs daily intake. Calories can be advanced 200 kcal every 2 days. After the first 2 weeks, a weight gain of 2â3 lb per week is a reasonable goal for the hospitalized patient. Oral refeeding is always preferable, but nasogastric and even intravenous feedings can be used in situations of food refusal and as a lifesaving measure. New research suggests that intensive nutrition regimens may allow patients to gain weight, muscle, and fat mass without significant side effects.

Activity

On admission, the activity level is typically restricted to bed rest so that energy can be directed towards weight gain and recuperation. As orthostatic symptoms improve, the activity level could be judiciously advanced.

Questions To Ask Your Doctor

  • Are there any medical conditions that could be causing my depression?
  • What are the side effects and risks of the antidepressant you are recommending?
  • Are there any foods or other substances I will need to avoid?
  • How will this drug interact with other prescriptions Im taking?
  • How long will I have to take this medication?
  • Will withdrawing from the drug be difficult?
  • Will my depression return when I stop taking medication?

Medication isnt your only option for depression relief

Remember, antidepressants arent a cure. Medication may treat some symptoms of depression, but cant change the underlying issues and situations in your life that are making you depressed. Thats where exercise, therapy, mindfulness meditation, social support and other lifestyle changes come in. These non-drug treatments can produce lasting changes and long-term relief.

Selective Serotonin Reuptake Inhibitors

The role of antidepressants in treating eating disorders

In the last decades, SSRIs have been increasingly used to treat AN, but only two have been tested in RCTs, with mostly negative results. Fluoxetine conveyed no advantage over placebo for underweight AN in-patients , nor for AN outpatients treated with fluoxetine plus serotonin precursors . Kaye et al. randomly assigned restricting AN patients to fluoxetine or placebo after in-patient weight gain. In the following year, women receiving fluoxetine had a significantly lower rate of relapse than those treated with placebo. However, limitations of this study include its small size , and the lack of standardized psychological treatment during the medication trial. In a larger RCT including 93 weight-restored outpatients randomized to CBT plus fluoxetine or placebo, Walsh et al. found no difference in relapse rate after 1 yr. Fassino et al. conducted a RCT comparing citalopram to a waitlist condition in restricting AN patients. Weight gain was similar in both groups, but citalopram appeared to improve depression, obsessive-compulsive symptoms, impulsiveness and trait-anger.

SSRIs in children and adolescents

Are Medications Helpful For Eating Disorders

Seeking treatment for an eating disorder can be hard sometimes due to resources, misconceptions about the treatment process, or because of the nature of the disorders themselves and research has shown that over 40% of individuals with an eating disorder dont get the help they might need.

When it comes to treatment options, sometimes people dont even realize that psychotropic medications are a possibility to consider. Psychotropic medications are those that affect your mind your emotions and your behavior typically by altering the balance of the chemicals in your brain called neurotransmitters. Precisely how changes in neurotransmitter levels lead to changes in how people feel and how they behave remains quite mysterious.

The main classes of drugs used in psychiatric treatment are known by the names associated with the condition the medication was first used to treat. For example, antidepressants are named as such because they were initially tested as a treatment for depression, but they are now used to target a range of mood, anxiety, and eating problems.

Are Teenagers Affected By Eating Disorders

Teenagers can be especially susceptible to eating disorders because of hormonal changes during puberty and social pressure to look attractive or thin. These changes are normal, and your teenager may only practice unhealthy eating habits every once in a while.

But if your teenager begins to obsess over their weight, appearance, or diet, or starts consistently eating too much or too little, they may be developing an eating disorder. Abnormal weight loss or weight gain may also be a sign of an eating disorder, especially if your teenager frequently makes negative comments about their body or perceived size.

If you suspect your teenager has an eating disorder, be open and honest about your concerns. If theyre comfortable talking with you, be understanding and listen to their concerns. Also have them see a doctor, counselor, or therapist to address the social or emotional issues that may be causing their disorder.

Research also suggests that men with eating disorders are underdiagnosed and undertreated. Theyre less likely to be diagnosed with an eating disorder, even when they exhibit similar symptoms as a woman.

Research suggests that many young men with eating disorders dont seek treatment because they consider them stereotypically female disorders.

Do I Need This Treatment

If you are distressed for more than two weeks by feelings of sadness, despair and hopelessness, or by excessive worry that is hard to control, see a doctor for an assessment of your symptoms and situation and to discuss treatment and support options. Early treatment can help to ensure treatment success.

Be sure your doctor knows if you have had times where you felt a reduced need for sleep in combination with an unusual amount of energy, or where your mood changed from feeling depressed to feeling unusually happy or irritable. Mood stabilizer medications may be more suited to your needs, either on their own or in combination with antidepressants. Antidepressants alone can cause some people to switch from depression into mania.

Medications are only one way of treating depression and anxiety. Talk therapies, such as interpersonal psychotherapy and cognitive-behavioural therapy, can be just as effective. Peer support, school and job counselling, and housing and employment supports can also help to deal with problems that may trigger or worsen depression or anxiety.

No Evidence Of Improving Depression Outcomes

OK, but what if we accept that even though the drugs are designed to increase serotonin and, even though low serotonin is not associated with depression, they still are effective in helping us manage depression? What if they are poorly understood, but still have incredible benefits? That would be great, but research has not shown that to be true.

  • For mild to moderate depression, the difference between placebos and antidepressants was nonexistent to negligible.
  • Paxil failed to demonstrate a statistically significant difference from placebo on the primary efficacy measures.
  • Drug companies publish only studies that show benefit, and almost none of the studies that show antidepressants are ineffective.
  • When all available studies are combined, 80% of people get better with just a placebo.

Lisdexamfetamine : Good Results Seen For Bed

Lisdexamfetamine is a stimulant used in the treatment of ADHD. In February 2015, it also became the first medication approved to treat moderate-to-severe BED.

Experts believe it helps curb impulsive and compulsive behaviors typically associated with BED, such as reaching for food when depressed or continuing to eat even once you feel full. In trials, lisdexamfetamine was significantly more likely than placebo to reduce the number of binge eating episodes per week, to result in complete cessation of binge eating, or to cause weight-loss. The most common side effects reported were dry mouth, decreased appetite, sleeplessness, and headache, although overall discontinuation rates because of side effects were low.

How Medication Treats Eating Disorders

A number of drugs, like certain antidepressants, are being used to successfully treat eating disorders. Read about the latest research.

With eating disorders, there is no exact formula for treatment. Every patient is different, and what works for one may not work for another. Eating disorder treatment usually entails some type of nutritional therapy and psychotherapy. Medication, in the form of antidepressants, is often prescribed, depending on the type of eating disorder and patients needs.

Eating Disorder Treatment: When Medication May Help

“Particularly for bulimia nervosa and binge eating disorder, medications are often used, but are rarely the sole form of treatment,” says Michael Devlin, MD, professor of clinical psychiatry at Columbia University Medical Center in New York City and associate director of the eating disorders research unit at New York State Psychiatric Institute.

“Treatment should take into account nutritional considerations, such as weight gain for anorexia nervosa or weight management for overweight or obese individuals with binge eating disorder, and psychotherapy to address the issues that are driving the eating disorder, Dr. Devlin continues.”

Eating Disorder Treatment: Medication for Anorexia

Medication is used less frequently to treat anorexia compared to other eating disorders because there is little evidence that shows it works, explains Devlin. “The best medicine for anorexia nervosa is food,” he says.

Antidepressants For Eating Disorders

Prozac is an SRI and has proven tosupport treatment for people with anorexia and depression.

· Cyproheptadine Is an antihistamine thatstimulates appetite and may help relieve depression associated with appetiteloss and improve appetite for people with anorexia. *Keep in mind that loss ofappetite is only one aspect of anorexia and generally develops in an advancedstage of the disease.

· Zyprexa People with anorexiaoften experience intense anxiety and subsequent depression in regard to food,their body weight and eating. Since adapting healthier dietary habits is keytoward managing and recovering from anorexia, medications that help alleviateanxiety may prove useful in treating emotional aspects of the disorder.  Zyprexa is a medication formally used totreat schizophrenia and may improve treatment for low-weight anorexia patients.Olanzapine works by reducing anxiety, obsessive thinking and depression causedby these symptoms.

· Antidepressant medicines reduce binge eating andpurging in up to 75% of people who have bulimia nervosa.

· Antidepressants regulate brain chemicals thatcontrol mood. Guilt, anxiety, and depression about binging usually lead topurging. Antidepressants help keep emotions stable and can help reduce the frequencyof binge-purge cycles.

· Antidepressants work best when combined withpsychological counseling for the treatment of bulimia.

How Are Eating Disorders Treated

The role of antidepressants in treating eating disorders

Eating disorders can be treated either by self-help or professional help. The type of treatment that is appropriate depends on the severity of the disorder, with more severe conditions needing professional help.

Bulimia can be tackled using a self-help manual combined with guidance from a therapist. Anorexia usually needs help from a clinic or therapist. Self-help involves:

  • trying to stick to regular mealtimes  breakfast, lunch and dinner. If body weight is very low, they should have extra snacks.  
  • keeping a diary of what is eaten, thoughts and feelings. This can be used to see if there are links between feelings, thoughts and what is eaten.

The GP can refer the patient to a specialist counsellor, psychiatrist or psychologist. The eating disorder may have caused physical problems and a physical health check is advisable. The physical consequences of eating disorders may require additional treatment.

There is a range of specific treatments for anorexia including:

Specific treatments for bulimia nervosa include:

Epileptogenic Effects Of Antidepressants

The complex neurotransmitter effects of antidepressant drugs make it impossible to offer simplistic assumptions about their proconvulsant effects. Recent experimental studies of AEDs used to treat depression lead to the conclusion that it is unlikely that alterations in serotonin and norepinephrine levels are related to an increased risk of seizures. In fact, some studies suggest that fluoxetine and doxepine may occasionally have anticonvulsant properties.

Norepinephrine Uptake Inhibitors And Serotonin Norepinephrine Reuptake Inhibitors

There has been one RCT indicating that the norepinephrine reuptake inhibitor atomoxetine was superior to placebo and fairly well tolerated in BED patients . In one retrospective review including 35 outpatients with BED and obesity, the serotonin norepinephrine reuptake inhibitor venlafaxine was associated with significant reduction in binge-eating frequency .

Evidence That Were Better Without The Drug

There is a surprising quantity of research suggesting that were better off without antidepressant drugs. It is worth reviewing the data:

The purpose of this article is to illuminate the fact that giving our kids antidepressant medication is not a given. Just because antidepressants are commonly prescribed, and are increasingly prescribed to children, does not mean that parents should assume they should do so without evaluating the evidence against giving kids antidepressants.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

Shes the editor of More-Love.org and a Parent Coach who helps parents handle their kids food and body issues.

Evidence For The Effectiveness Of Antidepressants In Bed Is Not Overwhelming

Unfortunately, trials that have been conducted have mostly shown inconsistent results.

Fluoxetine decreased binge-eating and caused weight-loss in one trial, but another trial reported no response to the drug in some people despite up to two years treatment.

Sertraline significantly reduced binges, overall illness severity and BMI compared with placebo in 18 people with BED, although the study only lasted 6 weeks.

Another study reported bupropion to be more effective than sertraline at reducing weight in BED patients with depression. However, no difference in symptoms such as binge-eating frequency, food cravings, or depression levels was reported when bupropion was compared to placebo in another trial. Trial participants did lose on average 1.8% of their BMI over the eight week trial period.

Although findings do not generally support using antidepressants as stand-alone treatments for BED, they may be considered when coupled with other interventions such as CBT or lifestyle changes.

What Does Antidepressant Medications Do

Antidepressant medications increase the activity of chemicals called neurotransmitters in the brain. Increasing the activity of the neurotransmitters serotonin, norepinephrine and dopamine seems to help lessen the symptoms of depression and anxiety. However, the brain is a very complex organ and the reasons why these drugs work are not yet fully understood.

We do know that these drugs help to relieve symptoms of depression and anxiety in up to 70 per cent of people who try them. This rate is even higher when people who dont get relief with one type of antidepressant try a second type.

Historical Information Important In The Diagnosis Of This Problem

Diet and compensatory behaviors

It would be important to ask about diet and any compensatory behaviors:

  • Exercise â How much? Frequency? How intense?

  • Diet â A typical dayâs food diary? Calorie counting? Food restrictions? Fluid and caffeine intake?

  • Binge eating â How often?

  • Purging â Frequency? How? Self-induced vomiting? When in relation to meals?

  • Use of laxatives, diuretics, enemas, stimulants or diet pills?

Review of systems

In general, individuals may feel fatigue or cold intolerance from decreased metabolism and poor perfusion. Dizziness, lightheadedness, syncope or palpitations could suggest orthostatic hypotension or tachycardia.

Recurrent vomiting could cause symptoms of gastroesophageal reflux, chest pain, and tooth sensitivity from loss of dental enamel. Common complaints of postprandial fullness or pain, nausea, constipation and bloating come from decreased gastrointestinal motility. Diarrhea from laxative abuse can cause symptoms of chronic dehydration and electrolyte abnormalities.

Weakness or muscle cramps can be exacerbated by electrolyte disturbances such as hypokalemia. Bone pain with exercise should raise suspicion of the possibility of stress fractures, osteopenia or osteoporosis.

Some patients may access pro-anorexia or pro-bulimia websites that lack professional supervision.

Medications

Diabetics may omit or underdose their insulin to reduce food metabolism. Thyroid hormone could be used to increase metabolism for weight loss.

Family history

What If My Child Has An Eating Disorder

If you think your child has an eating disorder:

Get help early. When an eating disorder is caught early, a person has a better chance of recovery. Make an appointment with your child’s doctor or an eating disorders specialist.

Talk to your child about your concerns. Be calm, direct, and caring. Let them know you will help. Ask them to tell you what it’s like for them.

Go to all appointments. Treatment takes time and effort. Work with the care team to get the help your child needs. Ask questions any time you have them.

Be patient and supportive. Learn what you can do to help your child. Try to keep your relationship with your child strong and positive. Make time to listen, talk, and do things that you both enjoy.

Evidence Of Brain Changes

The role of antidepressants in treating eating disorders

Perhaps the scariest concept of all is that antidepressant medication may actually cause chronic depression in people. There is evidence presented in that antidepressants and other psychological drugs actually cause the very problems that they are supposed to be fixing. In other words, those of us with depression will become chronically depressed.

For example, the National Institute of Mental Health found that people who were treated with antidepressants were nearly seven times more likely to become incapacitated by depression.

The trouble, according to , is that psychotropic drugs create chemical imbalances in the brain, and this helps turn a first-time customer into a long-term user, and often into a buyer of multiple drugs. The patients brain adapts to the first drug, and that makes it difficult to go off the medication.

Other investigators have reported that chronic fluoxetine treatment may lead to a 50 percent reduction in serotonin receptors in certain areas of the brain.

How Are Eating Disorders Diagnosed In Teens

Below are some diagnosis methods that a healthcare professional may use to diagnose eating disorders .

  • Physical examination: A doctor would check the teenâs height and weight to ascertain if they are in a healthy weight range. It would be followed by an examination of the vital signs, such as pulse rate, blood pressure, and breathing, to rule out any irregularities. The doctor would also examine the teenâs nails for chipping or brittleness, skin and hair for flakiness and dryness, and abdomen for swelling, pain, or any other discomfort.
  • Laboratory tests: Total blood count, urine test, liver, kidney, and thyroid function test are some tests a doctor would recommend to assess the teenâs health further. Additionally, the doctor may ask for a dental check, X-ray, or EKG/ECG to check for irregularities due to nutritional deficiencies, which may indicate an eating disorder.
  • Psychological evaluation: The mental health professional may ask questions about the teenâs eating habits and how they perceive their body image. These questions could be uncomfortable, but a teen must be motivated to answer honestly. Psychological evaluation could be vital to corroborate the results of the physical exam and lab tests.
  • Based on the diagnosis, the doctor would chart a comprehensive treatment plan to treat the eating disorder and its associated health issues.

    The Pharmacological Options In The Treatment Of Eating Disorders

    A. Capasso

    1Mental Health Unit, District 24, ASL Napoli 1 Centro, Molosiglio, Via Acton, 80145 Napoli, Italy

    2Department of Pharmacy, University of Salerno, Via Ponte Don Melillo, 84084 Fisciano, Salerno, Italy

    Abstract

    The eating disorders are complex systemic diseases with high social impact, which tend to become chronic with significant medical and psychiatric comorbidities. The literature data showed that there is good evidence to suggest the use of SSRIs, particularly at high doses of fluoxetine, in the treatment of BN reducing both the crisis of binge that the phenomena compensates and reducing the episodes of binge in patients with BED in the short term. Also, the topiramate showed a good effectiveness in reducing the frequency and magnitude of episodes of binge with body weight reduction, both in the BN that is in the therapy of BED. To date, modest data support the use of low doses of second-generation antipsychotics in an attempt to reduce the creation of polarized weight and body shapes, the obsessive component, and anxiety in patients with AN. Data in the literature on long-term drug treatment of eating disorders are still very modest. It is essential to remember that the pharmacotherapy has, however, a remarkable efficacy in treating psychiatric disorders that occur in comorbidity with eating disorders, such as mood disorders, anxiety, insomnia, and obsessive-compulsive personality disorders and behavior.

    1. Introduction

    2. Antipsychotics

    3. Antidepressants

    Tips For Stopping Your Antidepressant Safely

    Reduce your dose gradually. In order to minimize antidepressant withdrawal symptoms, never stop your medication cold turkey. Instead, gradually step down your dose , allowing for at least two to six weeks or longer between each dosage reduction.

    Dont rush the process. The antidepressant tapering process may take from several months to years, and should only be attempted under a doctors supervision. Be patient. If at any time you experience difficulties, consider spending more time at your current dose before attempting any further reductions.

    Choose a time to stop that isnt too stressful. Withdrawing from antidepressants can be difficult, so its best to start when youre not under a lot of stress. If youre currently going through any major life changes or significantly stressful circumstances, you may want to wait until youre in a more stable place.

    How To Prevent Weight Loss On Antidepressants

    If youre concerned about losing weight due to antidepressants, the good news is that most antidepressants dont cause weight loss.

    The main antidepressant to avoid if you would rather not lose weight is bupropion . 

    If youre already taking it and want to stop, ask your doctor for medical advice on tapering safely instead of stopping cold turkey, as you might experience a discontinuation syndrome with mild to severe side effects.

    Another option is to talk to your doctor about switching to a different antidepressant drug.

    Also, be sure to keep stress and anxiety in check, as they may lead to undereating and result in weight loss.

    Likewise, tell your doctor if youre experiencing insomnia, which may result in unwanted weight loss. 

    You can also speak to your doctor or therapist about a self-care plan that can help prevent weight loss.

    Safety Of Antidepressants In Anorexic Patients

    Tricyclic antidepressants and MAOIs are medications with narrow therapeutic indices and the potential to be lethal when taken in overdose or when mixed with benzodiazepine or alcohol.- Suicidal ideation and suicide attempts are common among anorexic patients, and self-poisoning with medication as a method of suicide is frequent in females aged 15 to 19 years. Tricyclic antidepressants are also associated with unwanted adverse effects, such as decreased seizure threshold, QT interval prolongation, orthostatic hypotension, and gastrointestinal symptoms ,- and thus can worsen preexisting gastrointestinal and cardiovascular conditions inherent to AN individuals. Bupropion decreases seizure threshold, and this risk is even higher in those AN and underweight patients. Bupropion is contraindicated in anorexic patients due to increased risk for new-onset seizures.,,

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