VINCENT SQUARE EATING DISORDER SERVICE
MEDICATION PRESCRIBED FOR BULIMIA NERVOSA:
ADVICE FOR SERVICE USERS AND CARERS
The mainstay of treatment for bulimia is some form of talking therapy. This is
usually offered individually (CBT is most commonly offered at Vincent Square
and CAT in very complex cases) or sometimes with your family to support
healthy eating patterns. This is through establishing regular meals that contain
enough energy to allow the body to maintain a healthy weight.
Prescribed medicines may be part of your care plan to treat bulimia. This leaflet
describes the different medicines most commonly prescribed.
ANTIDEPRESSANTS
Antidepressants can be used to help reduce the frequency of bingeing and
vomiting. They can also help treat symptoms of depression and obsessive
compulsive disorder which may occur at the same time as bulimia. The most
common family of antidepressants prescribed are called selective serotonin
reuptake inhibitors (SSRIs).
Antidepressants for Bulimia: The SSRIs help reduce the frequency of bingeing
and vomiting in the short term though the longer term effects are unknown. Alone
they have not been shown to be as effective as some talking therapies such as
CBT. They can be a useful first step, especially if there is a wait to access a
talking therapy. There is also some evidence that taking antidepressants at the
same time as having a talking therapy such as CBT can maximise your chances
of getting better. Fluoxetine (Prozac) is the usual first choice. You may be offered
a higher dose of SSRI for bulimia than you would take for depression.
Antidepressants for Depression: If you are not including enough
carbohydrates in your diet your body may struggle to make enough serotonin to
sustain a healthy mood. As a consequence people with bulimia often describe
low mood (feeling sad) and anxiety. Simply introducing carbohydrates such as
pasta, bread and potatoes in the diet can help improve the low mood associated
with bulimia. If you are below your medically recommended weight then simply
regaining to a healthy weight can help improve sleep, energy and concentration.
If your depressive symptoms are severe, longstanding or associated with suicidal
thoughts then your doctor may discuss adding in an antidepressant. The most
commonly used antidepressants are called selective serotonin reuptake inhibitors
(SSRI). E.g. fluoxetine, citalopram, or sertraline. Some other prescriptions such
as venlafaxine and mirtazapine are sometimes used. They work in a slightly
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different way but do a similar job. However they have slightly different side
effects and you should ask your doctor for an information leaflet.
If you are below your recommended healthy weight you may need to take a
higher dose of SSRI than would be usually necessary. (This is because your
body needs fat stores as well as a good carbohydrate intake to effectively
manufacture serotonin.) Antidepressants usually take between two and six
weeks to take full effect. It is recommended that you carry on taking them for at
least six months after your mood recovers. If you have experienced two or more
episodes of depression then you should consider taking them for two years or
longer. You should usually reduce the dose gradually rather than stopping
abruptly to avoid unwanted withdrawal symptoms.
Antidepressants for Obsessive Compulsive Disorder (OCD): People with
OCD experience recurrent distressing ideas, images or impulses that enter their
mind again and again. They usually try unsuccessfully to resist them and may
have rituals or things they do repeatedly to try and cope. Higher doses of SSRIs
can help reduce the intensity of these experiences. The SSRIs may take ten to
twelve weeks to reduce the OCD symptoms.
VITAMINS AND MINERAL SUPPLEMENTS
Multivitamins (Forceval): You may be offered multivitamin tablets to try to
minimise the harm caused by a restricted diet. This does not compensate for a
balanced and varied diet. However it may help prevent serious deficiencies until
you are able to manage a more complete mix of foods.
Potassium supplements (Sando-K, Slow-K): If you are overusing laxatives or
making yourself vomit regularly the balance of salts in the body can be affected.
Low potassium is dangerous as it can interfere with the hearts ability to beat
regularly. You can protect yourself from developing low potassium levels by
drinking oral rehydration salts such as Dioralyte after each episode of vomiting or
laxatives. If you do develop low potassium you may be asked to drink a
potassium solution three times a day to top up the levels of this salt and regulate
the heart’s rhythm.
Omeprazole: Alternatively if you are recurrently experiencing low potassium and
continuing to vomit you may be offered omeprazole. This reduces the amount of
acid released in the stomach and so helps prevent the acid imbalance in the
body which contributes to low potassium.
Vincent Sq Clinic J Arkell 8/7/2010
Vincent Sq Clinic M Raikkonen 04/04/2013
Vincent Sq Clinic J Arkell 8/7/2010
Vincent Sq Clinic M Raikkonen 04/04/2013