Antidepressant medicines reduce binge eating and purging in up to 75%
of people who have
bulimia nervosa.1
Antidepressants that are most commonly used to reduce the binge-purge cycle
associated with bulimia are:
- Fluoxetine (such as Prozac), which is a selective serotonin
reuptake inhibitor (SSRI). Other SSRIs have not yet been proven to be effective
for bulimia.
- Tricyclics, such as imipramine (Tofranil, for
example), amitriptyline, and desipramine (Norpramin, for example).
Antidepressants regulate brain chemicals that control mood.
Guilt, anxiety, and depression about binging usually lead to purging.
Antidepressants help keep emotions stable and can help reduce the frequency of
binge-purge cycles.2
Antidepressants may
produce some side effects. But side effects may be reduced or may go away after
several weeks of treatment.
Before starting an antidepressant,
tell your doctor about every medicine or supplement (prescription or
nonprescription) that you are taking. Some antidepressants can have serious
interactions with other medicines or dietary supplements.
Fluoxetine
Fluoxetine (such as Prozac) reduces
binge-purge cycles in bulimia.3
Studies
show that the side effects of fluoxetine bother people less than the side
effects of other antidepressants, such as tricyclics.4
This medicine also has a low risk of overdose, and it does not require diet
changes. Although side effects of fluoxetine are usually mild, they can include
nausea, loss of appetite, diarrhea, anxiety, irritability, problems sleeping or
drowsiness, loss of sexual desire or ability, headaches, dizziness, and dry
mouth.
Tricyclic antidepressants
Tricyclic side effects can
include stomach upset, constipation, dry mouth, blurred vision, and drowsiness.
Some people gain weight and have problems with sexual desire and ability.
Tricyclics are started in low doses and gradually increased to avoid overdose
and other serious side effects.
FDA Advisory
The U.S. Food and Drug Administration
(FDA) has issued an
advisory on antidepressant medicines and the risk of
suicide. The FDA does not recommend that people stop using these medicines.
Instead, a person taking antidepressants should be watched for
warning signs of suicide. This is especially important
at the beginning of treatment or when the doses are changed.
What to think about
You may start to feel better
within 1 to 3 weeks of taking antidepressant medicine. But it can take as many
as 6 to 8 weeks to see more improvement. If you have questions or concerns
about your medicines, or if you do not notice any improvement by 3 weeks, talk
to your doctor.
Antidepressants work best when combined with
psychological
counseling for the treatment of bulimia.5
Studies have found daily use of SSRIs may
increase the risk of bone fracture in adults over age 50. Talk to your doctor
about this risk before taking an SSRI.
People who purge after they
take antidepressants may not get enough of the medicine into their blood.
Health professionals may recommend that they take antidepressant medicine at
bedtime after they have stopped purging. People who purge often need to have
their blood checked regularly to measure the amount of medicine in their
bloodstream.
