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Extract: Medication (Part 2) - Psychotropic Medications Commonly Used in Eating Disorders
Date: 3rd October 2005
Reference: Costin C., The Eating Disorder Sourcebook 2nd Edition (1999) Lowell House, Illinois


Antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs): Used for obsessive compulsive behaviours, depression and anxiety disorders like panis, social phobia, and post-traumatic stress disorder. Have been shown to decrease binge/purge behaviour when used in higher doses (e.g., 60 mg Prozac). May diminish obsessive, rigid thinking and ritualistic behaviour traits. Fluoxetine (Prozac) trials have shown that administering the drug after weight restoration in anorexia nervosa may prevent relapse. Low risk of suicidal overdoses with these medications.
Cautions: These medications may not be used in pregnancy, particularly first trimester, unless absolutely necessary. This class of medications is not addicting, but there may be side effects with abrupt withdrawal of Paxil, Zoloft, and Luvox. A gradual tapering off is recommended. Drug interactions do occur. It is important for the prescribing doctor to know abuot all drugs being taken, including over-the-counter drugs and herbs or homeopathics. Monoamine oxidase inhibitors (MAOIs) cannot be used within two weeks of beginning to take SSRIs. MAOIs cannot be started until five to either weeks after discontinuations of Prozac.
Most common side effects: anxiety, nervousness, insomnia, agitation, gastic irritation, fatigue, drowsiness, sweating, tremor, anorexia (loss of appetite), diarrhea, dizziness, lightheadedness, sexual dysfunction, decreased libido.
Examples of general dosing:
Prozac (fluoxetine): 10-80 mg a day
Zoloft (sertraline) 25/200 mg a day
Paxil (paroxetine) 10-50 mg a day
Luvox (fluvoxamine) 50-300 mg a day
Celexa (citalopram) 10-60 mg a day

Norepinephrine-Dopamine Reuptake Inhibitor (NDRI): Wellbutrin (Bupropion). According to the Food and Drug Administraion (FDA), this medication should not be used in patients with active eating disorders because of the higher risk of seizures.

Serotonin Norepinphrine Reuptake Inhibitor (SNRI): This new antidepressant has not yet been studied in eating disorders, but theoretically it should be helpful. This medication is used for depression and anxiety disorders, including generalised anxiety disorders. Weight gain or loss may accur, with correspondind alteration in appetite. There is no clear advantage over SSRIs in terms of side effects. it many have a more stimulating effect and has been knwon to cause nausea. Overall, however, this drug does tend to have fewer side effects than the tricyclics. There is a lower suicide potential for overdose with this drug tha there is with tricyclics, but the potential may be higher than that with SSRIs.
Most common side effects: Nausea and increased blood pressure (hypertension).
Examples of general dosing:
Effexor (Vanlafazine) 37.5mg two times a day to 300 mg total given in two doses a day.

Serotonin Antagonist Reuptake Inhibitors (SARIs): This is another new class of antidepressant not yet studied in eating disorders but used in depression and anxiety disorders. Compared to the SSRIs the SARIs have the advantage of not causing or increasing anxiety, insomnia, or sexual dysfunction.
Most common side effects: Sedation and nausea
Example of general dosing:
Serzone (Nefaxodone) 100-600 mg a day.

Tricyclic: Reduce depression and panic attacks and may diminish bingeing and purging behaviours. Generaly case increased appetite and weight gain. Generally cause more sedation than SSRIs. Much lower threshold for successful suicide, as they significantly affect heart function in higher doses; commonly used in overdose attempts. Rapidly absorbed from the stomach. Have more side effects than SSRIs. Certain medications may increase blood levels without an actual increase in dose. This may place the person takign the medication at increased risk for side effects or inadvertent overdose. Can see side effects with abrupt discontinuation. Tapering is recommended, just as with SSRIs. Don't use with MAOIs. Therapeutic blood levels can be beneficial.
Common side effects: Constipation, blurry vision, urinary hesitancy, possible affect on cardiac function, weight fains, increased appetite, possible decrease in libido.
Examples of general dosing:
Desipramine 100-300 mg a day
Imipramine 100-300 mg a day
Notriptyline 50-150 mg a day
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