Extract: Medication (Part 3) - Psychotropic Medications Commonly Used in Eating Disorders
Date: 3rd October 2005
Reference: Costin C., The Eating Disorder Sourcebook 2nd Edition (1999) Lowell House, Illinois
Used primarily for mood stabilisation in bipolar (manic-depression) disorder or mood swings. May help stabilise mood instability in persons with borderline personality orgainsation and various disorders of brain function. Can sometiems be used as augmentors in individuals who are not responding to antidepressants.
Depakote/valproic acid derivatives: Primary use is as anticonvulsant. May cause liver failure as more severe side effect. Can be fatal. Genereal dosage range 500-2000 mg. Causes less with gain than lithium, but more than Tegretol. Blood serum levels must be checked. Gastrointestinal side effects may occur. Toxic levels can be fatal.
Carbamazepin (Tegretol): Anticonvulsant and mood stabiliser. Worse side effect aplastic anemia. Can be fatal, but rare (1 in 50,000). Gastrointestinal side effects do occur. Blood levels must be checked. Causes less weight gan than lithium and Depakote. Toxia levels can be fatal. Dose range 200-2000 mg.
Lithium salt: May cause weight gain, acne, retention of water, hypothyroidism, excessive secretion of urine, excessive thirst. Replacement of water loss is essential or toxicity will occur. Toxic levels will kill and are more likely with decreased potassium. Patients generally will not use if aware of risk of weight gain. Dose range 600-3000 mg in eating disordered clients. Probably should be avoided in eating disorders due to lithium toxicity associated with low potassium and dehydration.
Lamictal (lamotragine): A newer anticonvulsant sowing promise as a mood stbiliser. No blood levels necessary.
Generally benign in regards to side effects, but have significant effects in overdose. Most important concern is addiction potential. Short term use is acceptable and long-term use sometimes necessary in severe anxiety disorders not responsive to SSRIs. In order of most to least addicting: Atican, Klonopin (most commonly used for long term treatment).
Examples of general dosing:
Ativan: 0.5-2.0 mg two to four times per day
Klonopin: 0.25-1.0 mg two to four times per day
Buspirone (Buspar): A new nonaddictive antianxiety drug that works differently that the benzodiazepines (e.g., Xanax, Valium). Used in generalised anxiety and as an adjunct to antidepressants for refractory depression and obsessive compulsive disorder.