The combination of binging and purging can be tremendously difficult on the body and could lead to a number of medical complications if left untreated, including electrolyte imbalances, tooth decay, higher risk of a major coronary event, and, in severe cases, death.
To help combat some of the worst bulimia symptoms, doctors sometimes prescribe medication. And while these drugs are typically safe when used as intended, they still have been associated with some side effects, and come with some important risks to consider.
What Kinds of Medications Are Used to Treat Bulimia?
Though clinical psychopharmacology has come a long way in treating a number of mental health conditions, approved medications to treat eating disorders are fairly limited.
For help treating bulimia nervosa, only fluoxetine (Prozac) has received official approval for use. [1] Generally, this drug works to increase serotonin levels in the brain, which can help elevate mood and positively impact other factors that influence eating disorders.
Some research has also pointed to topiramate as potentially useful for treating BN, though the drug has previously been used to help with epileptic seizures, migraines, and alcohol dependency. [1]
Medications for Common Co-Occurring Conditions
Rather than treating eating disorders specifically, medications may also be prescribed to help someone better manage any co-occurring mental disorders or personality disorders that can contribute to their eating disorder.
Selective serotonin reuptake inhibitors (SSRIs) and the medication mirtazapine have often been used to help with certain types of depression. [1] Depressive disorders are common among people with bulimia nervosa and can work to uphold the low self-esteem and poor body image that are often at the core of the condition.
Lamotrigine can help people with bulimia nervosa who are experiencing a depressive episode associated with bipolar disorder. [1] And risperidone is sometimes used for patients with bipolar disorder who are experiencing manic episodes. [1] During either extreme, someone may be more susceptible to disordered thinking patterns that can lead to disordered eating behavior.
Anxiety disorders are also common among people with BN. Patients dealing with acute anxiety or suicidal behavior or thoughts on top of their eating disorder are sometimes helped with a combination of benzodiazepines and lorazepam. [1]
It’s not just mental health that’s aided by medication. Physical symptoms of bulimia nervosa are also sometimes treated with medication, including proton-pump inhibitors and gastroprokinetic drugs to help with gastrointestinal distress, and hormone treatments to help with any number of common symptoms. [1]
The Dangers of Bulimia Nervosa Medications
No action is without a reaction, particularly when it comes to chemistry. While taking a prescription drug for bulimia nervosa or other eating disorders, such as anorexia nervosa or binge eating disorder, there is always the potential for consequences.
And while these medications are generally fine when taken as directed, they could still lead to serious complications if dosed or taken incorrectly.
Fluoxetine
The main medication used to help treat bulimia, fluoxetine, is in a class of medication called selective serotonin reuptake inhibitors (SSRIs).
When taken as intended, these medications aren’t typically dangerous, although some side effects associated with fluoxetine include: [2]
- Anxiety
- Diarrhea
- Difficulty falling asleep or staying asleep
- Dry mouth
- Excessive sweating
- Headache
- Confusion, difficulty concentrating, or memory problems
- Heartburn
- Loss of appetite
- Nausea
- Nervousness
- Sexual dysfunction
- Stuffy nose
- Unusual dreams
- Weakness
- Weight loss
It’s also possible to overdose on fluoxetine. This is a serious medical complication and should be treated as a medical emergency.
A fluoxetine overdose may include: [2]
- Coma
- Confusion
- Dizziness
- Fainting
- Fever
- Extreme nervousness
- Rapid, irregular, or pounding heartbeat
- Seeing things or hearing voices that do not exist (hallucinating)
- Seizures
- Uncontrollable shaking of a part of the body
- Unresponsiveness
- Unsteadiness
Topiramate
Topiramate, the medication being researched for use as another treatment option for BN, is in a class of medication called anticonvulsants.
This kind of medication is associated with its own set of side effects, with some of the more common symptoms, including: [3]
- Back, muscle, leg, or bone pain
- Change in ability to taste food
- Constipation
- Drowsiness
- Dry mouth
- Excessive menstrual bleeding
- Headache
- Missed menstrual periods
- Nausea
- Nervousness
- Nosebleed
- Numbness, burning, or tingling in the hands or feet
- Slowed reactions
- Stomach pain
- Uncontrollable eye movements
- Uncontrollable shaking of a part of the body
- Weakness
- Weight loss
Topiramate is also associated with an increased risk of experiencing bone problems, including osteoporosis in adults and rickets in children.
As with fluoxetine, it’s possible to overdose on topiramate, and this should likewise be considered a medical emergency and treated as such.
Signs of an overdose on topiramate include:
- Agitation
- Blurred vision
- Depression
- Dizziness
- Double vision
- Drowsiness
- Fast, shallow breathing
- Loss of appetite
- Loss of consciousness
- Loss of coordination
- Pounding or irregular heartbeat
- Seizures
- Speech problems
- Stomach pain
- Tiredness
- Trouble thinking
- Vomiting
Both fluoxetine and topiramate are associated with an increased risk of suicidal thoughts. If you or a loved one experience these types of thoughts, you should contact your doctor immediately. If you intend to act on these thoughts, call 911 or the 988 Suicide & Crisis Lifeline immediately.
The Dangers of Other Mental Health Medications
Almost all prescription medications, including those prescribed for bulimia nervosa or co-occurring mental health conditions, have a variety of drugs that should not or can not be taken with.
Certain combinations may increase the risk of developing health complications, while others may change the way the medications act in the body.
If you’re regularly taking any type of medication, make sure to discuss this with your doctor before taking any additional prescriptions for bulimia nervosa or a related mental health diagnosis.
Additionally, many types of medication should generally not be taken with alcohol or within several hours of drinking. This can be particularly taxing on the liver, or cause less severe symptoms, such as drowsiness.
Additional Risks of Bulimia Nervosa Medication
Thankfully, neither SSRIs nor anticonvulsants are typically considered to have a high potential for abuse. They don’t generally produce a significant narcotic effect that might tempt a person to misuse them.
SSRIs can sometimes lead to physical dependence, causing withdrawal symptoms if someone stops taking them, but this is different from a drug having the potential for widespread abuse. [1]
Sadly, of greater concern is a person intentionally misusing or attempting to overdose on these drugs, in an attempt to harm or even kill themselves. [4]
Because SSRIs and anticonvulsants can increase the risk of someone experiencing suicidal ideation, it’s important for both the person taking these drugs and those around them to pay close attention to how they feel. If a negative change is noticed, it’s important to talk to a doctor. If you or someone is considering acting on these thoughts, you should call 911 or a suicide hotline as quickly as possible.
Other Types of Eating Disorder Treatment
Medication isn’t the only type of treatment for bulimia nervosa or other types of eating disorders. In fact, many patients take these drugs as a supplementary treatment, along with regular psychotherapy sessions.
Cognitive behavioral therapy (CBT) is the most widely-recommended therapeutic modalities to treat BN. This program operates off the idea that unhelpful behaviors are derived from unhelpful thoughts, and patients are taught to first recognize, then redirect, and, eventually, eliminate these types of thought patterns.
Dialectical behavioral therapy (DBT) is another popular method for helping treat bulimia nervosa. It focuses on many of the same aspects as CBT, but brings in a number of additional tools, including mindfulness techniques, to help someone not only change themselves but learn to simultaneously love and accept themselves.
Group therapy, family therapy, and art therapy are other common treatments used to improve BN. And the disorder is also frequently helped through nutrition counseling and education.
Finding Help for Bulimia Nervosa
If you or a loved one are struggling with undiagnosed bulimia nervosa, it’s important to seek help.
Speaking with your primary care physician or your mental health therapist can be a good first step toward learning more about the condition and the specific types of programs that may be most beneficial for you.
But the most important thing to remember is that help is always available. Whether through medication, psychotherapy, or other methods, getting treatment for this type of dangerous disorder can be the first step on a path toward long-term recovery.
Resources
- Himmerich, H., Kan, C., Au, K., Treasure, J. (2021). Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition and physical health consequences. Pharmacology & Therapeutics; 217.
- Fluoxetine. (2022, January 15). National Library of Medicine. Retrieved December 2022.
- Topiramate. (2022, November 15). National Library of Medicine. Retrieved December 2022.
- Coupland, C., Hill, T., Morriss, H., Arthur, A., Moore, M., Hippisley-Cox, J. (2015). Antidepressant Use and Risk of Suicide and Attempted Suicide or Self Harm in People Aged 20 to 64: Cohort Study Using Primary Care Database. BMJ; 350.