Psychopharmacology in the treatment of eating disorders

Not withstanding the primacy of psychological treatments, pharmaceutical agents have an important role in the management of eating disorders (EDs). Those addressed in this chapter include psychotropic medications and weight management therapies. In addition to a role in treating comorbid depression, antidepressants appear to have a specific effect in appetite regulation in EDs characterized by recurrent binge eating, namely bulimia nervosa (BN) and binge eating disorder (BED). In the treatment of BED investigators have tested selective serotonin (5-HT) reuptake inhibitors (SSRIs) and tricyclics (TCAs) against placebo. Early trials of typical antipsychotics, such as chlorpromazine, pimozide, and sulpiride, reported inconsistent findings and problematic adverse effects. In patients with obesity and an ED, most commonly BED, orlistat has been found to aid weight diminution in two placebo-controlled trials, one combined with a reduced-calorie diet and one with guided self-help cognitive-behavioral therapy (CBT).