Medication for Treating Eating Disorders

The Psychiatrist's Role And Medication

The Psychiatrist

A psychiatrist who is knowledgeable about eating disorders is an integral part of the treatment team. Psychiatrists are medical doctors trained in the use of psychotropic medications who can perform psychotherapy and prescribe drugs. Depending on their preference, psychiatrists perform psychotherapy, prescribe medication, or both. Psychiatrists also can be extremely valuable in the diagnosis of eating and related disorders.

A psychiatrist can be brought in as part of a treatment team at any time but is usually consulted in the beginning as part of assessment, diagnosis, and treatment. A dietitian or therapist working with a client or patient may decide that additional help is needed and a referral for medication that affects mental functioning is warranted. As with all professionals, it is important that the psychiatrist have experience in treating eating disorders and is understanding of the complexity and special needs of this population. Aside from this, there are other things to look for when choosing a psychiatrist.

A psychiatrist should:

• be willing to work collaboratively as part of a treatment team;

• not be too quick to suggest, or rely on, medication alone, particularly when other methods have not been tried and nutritional rehabilitation has not been started;

• communicate regularly with other members of the treatment team;

• clearly explain the expected benefits of any medication prescribed and its side effects;

• be empathic and understanding toward the patient;

• be board certified or board eligible;

• be able to discuss the current research and trends in eating disorder treatment;

• communicate regularly with family members when appropriate; and

• clearly spell out all policies regarding fees, emergencies, paging procedures, cancellation policies, what to do in case of problematic medication reactions, and other issues.

The psychiatrist is a valuable treatment team member, if not the leader of the team. Whether or not medication is being prescribed, the psychiatrist can add another dimension and perspective to evaluation and treatment, ideally one that is integrative in nature. Psychiatrists should have an understanding of the biological aspects of eating disorders and other medical or psychological disorders that go along with them. Psychiatrists treating eating disordered patients should keep updated in the field of assessment and treatment with psychotropic medications for eating and related disorders.

The Psychiatrist as Part of a Treatment Team

It is vital that therapists, psychiatrists, and other physicians or treatment team members working with an eating disordered patient have a good working relationship with each other. Clinicians need to work as a team, giving patients and significant others the same or similar input. Release forms should be obtained from the patient so that all parties may contact each other to discuss the case on an ongoing basis.

The therapist and physician (hereafter used to refer to both the psychiatrist and the medical doctor) must work together and with input from the team on the treatment approach, including what they expect from the patient, the kind of diet and exercise advice to be given, the need for supplements, recommendations to the parents, and criteria for hospitalization. If the therapist and physician are not working together with the same goals, the patient hears different messages and uses this as an excuse not to listen to anyone, because "No one really knows what is best." Patients may think, "They can't even agree on what to do, so why should I listen to them?" In order not to undermine what one another says or does, clinicians must remain in constant contact with each other regarding the patient.

Communicating frequently is important even if it takes extra work, because someone, especially if he hasn't had experience with eating disordered patients, may unknowingly make statements that are counterproductive or contrary to the others' treatment. An example of this counterproductiveness happened when the physician of a seventeen-year-old anorexic patient told her parents that they needed to "lay down the law" and should not allow her to have any kind of diet foods like nonfat milk, diet soda, or low-fat dinners, and that she must gain 2 pounds per week. This was in contradiction to what the therapist was telling the family and the patient.

It is difficult for a therapist or family member to tell a physician that he has done something wrong or is negating other treatment taking place. Even when this is discussed, the physician may disagree. In the example above, the proof may come when the patient will not do what the physician has suggested anyway, and it is realized then that there is much more to treatment than simply "laying down the law." In other conflicts, the physician may appropriately prescribe a necessary hospitalization to a reluctant therapist or naive parents. In any case, the physician, therapist, and all members of a treatment team should communicate and work together closely to avoid adding unnecessary confusion, difficulties, delays, or doubts to the already complex problems patients have.

Medication

Dr. Arnold Anderson, a leading researcher in the field of eating disorders, said at a lecture on medication and eating disorders, "To every complex problem there is a simple answer . . . and it's wrong." People would like to find a simple answer to the complex problem of eating disorders and, in looking, have gone down the "isn't there medication for this?" path. The use of psychotropic (mind-altering) medication, otherwise known as "pharmacotherapy" or "psychopharmacology," may indeed play a significant role in the treatment of some cases of eating disorders, but it has not proven by any means to be a cure. Pharmacotherapeutic solutions are sought for a variety of clinical challenges presented by individuals with eating disorders; these are summarized below.

Possible Uses of Pharmacotherapy in Eating Disorders Treatment

• Other coexisting psychiatric conditions (along with the eating disorder)

• Weight restoration or loss

• Normalize thinking processes Normalize mood

• Induce/reduce hunger, increase/decrease satiety

• Reduce sensitivity to stress

• Reduce anxiety

• Relapse prevention

advertisement

In some cases, nutritional rehabilitation and weight restoration alone have been enough to eliminate obsessive-compulsive behavior and depression, whereas in others, they are not. Ideally, the use of medication should be tried only after nutritional rehabilitation has been initiated. However, this presents the proverbial catch-22 when nutritional rehabilitation cannot be accomplished, such as in a recalcitrant anorexic, and the treating professionals often search for medication to help accomplish that goal. Under these circumstances, trial and error and more trial seem to be the order of the day.

pages 1 2 3

By Carolyn Costin, MA, M.Ed., MFCC - Medical Reference from "The Eating Disorders Sourcebook"

top ~ next ~ send page to a friend