The role of psychiatry in the treatment of disorders
By virtue of their classification as a mental illness, this means that eating disorders of all descriptions will invariably involve anti-depressants being prescribed in as one facet of the multi-disciplinary approach that will be adopted in the ultimate and effective treatment of the disorder. It must be noted however that the role and appropriateness, as well as the ultimate efficacy of psychopharmacology has been fiercely debated and remains a contentious issue.
It is imperative to be aware that the usage of psychopharmacology in the treatment of eating disorders is not intended to tackle the eating disorders in and of themselves.
The reason for this is that clinical studies that have been conducted into the issue of eating disorders has identified that the sufferers of such conditions do not suffer from the eating disorders in a vacuum or in isolation, and so as such; there is a strong correlation between eating disorders and psychiatric comorbidity. What this means in practical terms then is that people afflicted with eating disorders will also be plagued with other psychiatric disorders and pathologies including obsessive compulsive disorder, anxiety attacks, low self-esteem and borderline personality disorder (BPD).
These underlying conditions serve to both cause and contribute towards the intensity, severity and frequency of eating disorders and so this is the keystone defence upon which psychotropic and anti-depressant medication is prescribed.
Bulimia nervosa and the usage of psychotropic medication
Of the numerous and differing types and variants of eating disorders that exist, bulimia nervosa has provided both the sufferers afflicted with the condition as well as the healthcare professionals involved in the handling of their care with some small measure of comfort . The reason for this is due to the fact that bulima nervosa is typically more responsive to the usage of psychotropic medication, and clinical studies have proven the relative efficacy of these drugs.
Benefits of the usage of psychotropic medication in the treatment of bulimia nervosa
One of the primary benefits that antidepressant medication will provide a person who is currently suffering from bulimia nervosa is that there is a significant decrease in the frequency upon the vicious binge/purge cycle which is endemic and one of the defining features of the condition.
The relative efficacy of the usage of psychotropic medication in the treatment of bulimia nervosa
Current studies currently class the relative efficacy of antidepressant medication in the treatment of bulimia nervosa at the 20-33% (approximately). Although this figure is and can be considered fairly low, it is imperative that we appreciate the actual quality of change that is brought about by virtue of the strategic use of this medication. Specifically, the aforementioned 20-33% of sufferers of bulimia nervosa will either achieve a total and absolute remission of their symptoms or at the very least, a significant reduction of them.
Furthermore, of the patients who do not manage to achieve total success but only a partial degree of it will have their symptoms reduced to such a level that they are then far more receptive and responsive to the usage of other, potentially more emotionally turbulent and invasive treatment methods such as eating disorder support groups and cognitive behavioural therapy.
The evolution of the psychotropic medication paradigm for the treatment of eating disorders
It is also important to appreciate that the aforementioned figures were derived from the usage of the old regime of psychotropic medication, which are primarily composed of mono-amine oxidase inhibitor (MOAIs) agents as well as tricyclics.
As such, these drugs are now being phased out in a staggered manner in order to usher in and make way for the Selective Serotonin Receptive Inhibitors (SSRI) based medication which promise very exciting new advances and benefits to the treatment of the condition.
In particular, Prozac has proven itself to be exceptionally efficacious at the controlling and reducing of the symptoms attributed to and caused by the eating disorder bulimia nervosa, and even more impressively, with none of the dreadful and risky side effects that were common.
Risks and drawbacks of the usage of psychotropic medication in the treatment of bulimia nervosa
The usage of psychotropic drugs in the treatment of bulimia nervosa has not been without criticism or controversy, and there has been a great deal of concern expressed about the relative safety and long-term health risks that such medication poses to the patient.
The risks of the usage of MAOI based medication in the treatment of bulimia nervosa
One of the primary reason that SSRI based medication is becoming so prominently used is due to the fact that many of the MAOIs, and more specifically, desiprimine and imipramine were notorious for bringing about and causing a myriad of different side effects. One of the most alarming of these was weight gain, which, although may seem beneficial given the nature and context of the condition that they were treating, quickly proved to be counter-productive.
The reason for this was that the weight gain was uncontrollable, and given the relatively low self-esteem that bulimia nervosa sufferers have, this meant that the increase in their weight would then be taken to be a reflection of their perceived weaknesses and flaws. In an attempt to redress the balance then, the bulima nervosa sufferer would then proceed to wage war upon their body, resulting in a significant uptake of the binging/purging cycle.
In addition, further complications were noted and recorded with the usage of MAOIs, and this was due to the fact that in order for the medication to work relatively unmolested and unimpeded, it was necessary for the eating disorder patient to be bound by the terms of a very restrictive and limited diet that significantly curtailed their intake of tyrosine.
If this precarious balance was ever upset to any degree, then this could have devastating and tragic, even deadly consequences: one of the ultimate side effects of excess tyrosine concentration in the body would be a hypertensive crisis that could potentially result in the untimely death of the patient.
In conclusion, the world of psychiatry has gratefully and warmly welcomed the introduction of the SSRI medication for the treatment of eating disorders, by virtue of the limited side effects they provide.