Bulimia nervosa medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Medical Therapy
Treatment is most effective early in the development of the disorder, but since bulimia is often easy to hide, diagnosis and treatment often come when the disorder has already become a static part of the patient’s life
Historically, bulimics were often hospitalized to end the pattern and then released as soon as the symptoms had been relieved. But this is now infrequently used, as this only addresses the surface of the problem, and soon after discharge the symptoms often reappeared as severe, if not worse.
Several residential treatment centers offer long term support, counseling, and symptom interruption. The most popular form of treatment involves therapy, often group psychotherapy or cognitive behavioral therapy. Anorexics and bulimics typically go through the same types of treatment and are members of these same treatment groups. This is because anorexia and bulimia often go hand in hand, and often patients have at some point suffered from both. Some refer to this as "symptom swapping". These forms of therapy address both the underlying issues which cause the patient to engage in these behaviors, and the food symptoms. In combination with therapy, many psychiatrists prescribe anti-depressants or anti-psychotics. Anti-depressants come in different forms, and the most promising one has been Prozac. In a study of 382 bulimics, those who took 20 to 60 mg of Prozac reduced their symptoms from 45% to 67%, respectively. It is possible that several other drugs could be more effective, but often insurance companies will not pay for other drugs until the patient has tried Prozac, because it has some positive outcome results.
Anti-psychotics are used in smaller doses than for treating schizophrenia. With an eating disorder, the patient perceives reality differently and has difficulty grasping what it is like to eat normally. Unfortunately, since this disorder has only recently been recognized by the DSM, long-term outcomes of people with the disorder are unknown. Current research indicates that up to 30% of patients rapidly relapse, while 40% are chronically symptomatic.
The rate in which the patient receives treatment is the most important factor affecting prognosis. Those who receive treatment early on for the disorder have the highest and most permanent recovery rates.
Dr Sabine Naessén from the Karolinska Institute discovered that some female patients suffer from a hormonal imbalance of over-production of the male hormone testosterone, that can be countered by a contraceptive pill containing estrogen, resulting in a reduction of the symptoms of bulimia.[1] Further studies are required to determine the efficacy of such a treatment.