TREATMENT OF BULIMIA NERVOSA: ABOUT NEW ANTIDEPRESSANT AND ANTIDEPRESSANTS USE
New antidepressant
The most popular antidepressant in the United States these days is Prozac, the brand name of fluoxetine. Part of the reason for the enormous success of this medicine is that its side effects, when present, are often less troublesome than those of other antidepressants. While many antidepressants act on a variety of neurotransmitter systems, Prozac appears to work exclusively on the serotonin system. While some other antidepressants can cause weight gain, Prozac seems less likely to do so—a feature of particular interest for people with eating disorders. In fact, some people taking Prozac experience a decrease in weight.
Another interesting feature of Prozac is that it seems to reduce obsessive thinking in some patients. There is growing research on the overlap between obsessive-compulsive disorder and anorexia, and Prozac is being evaluated for its effectiveness in both or these disorders. Current evidence seems to show that Prozac is as effective in reducing bingeing in bulimia as other antidepressants. Side effects can include agitation, nausea, fatigue, and insomnia. But on the whole, it is well tolerated by most patients.
When to Use Antidepressants?
Different doctors use medications differently. Some feel confident that these drugs work and should be tried first. Doing so, they feel, is cost-effective, and produces the most benefit in the shortest time. Other doctors prefer to use the various forms of psychotherapy. Then, if those strategies fail to produce enough improvement, they’ll decide whether to step up to the use of medications.
Although I am convinced antidepressants can work, I am not so sure they result in long-term improvement once the patient stops taking them. If the patient’s psychological, social, and family pressures haven’t changed, then it’s possible that her illness will persist or return. Of course, I will usually not hesitate to use antidepressants in patients who also have a clinical depression.
Research hasn’t yet shown how long a bulimic patient should keep using antidepressants. As a rule, if the patient shows improvement during the initial six-week trial, we continue with the drug for at least six months. Doing so decreases the possibility of relapse.
Many patients fear using medications. They are afraid the drug will make them “high,” like cocaine, or that they will become addicted. I try to reassure patients that such fears are groundless. While antidepressants do help a depressed person return to a normal mood, they do not produce a “high” in someone who is already at a normal level. They are also not addictive.
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