Medication enthusiasts might grow frustrated over what appears to be a slow pace of new discovery in medication-assisted treatment for substance addictions, but this area of research actually is far ahead of what's been accomplished in identifying medication treatments for eating disorders.
Yet that doesn't mean medications aren't playing an important supporting role in eating disorders care, and two physicians at the Feb. 26-March 2 International Association of Eating Disorders Professionals (IAEDP) symposium will offer their perspectives on the science and art of managing medication use for this patient group.
Ovidio Bermudez, MD, medical director of child and adolescent services and chief medical officer at the Eating Recovery Center of Denver, says medications have been most useful to this point in treating psychiatric comorbidities commonly seen in eating disorder patients and in addressing certain symptoms off-label. “On-label, we have very limited options right now,” says Bermudez.
Bermudez's co-presenter at the symposium, which will be held in St. Petersburg, Fla., will be Anna Vinter, MD, medical director of partial hospitalization and intensive outpatient programs at the Eating Recovery Center of California, which is affiliated with the Denver program.
While the eating disorders field is not rich with ongoing trials of novel pharmaceutical agents for treatment, there has been mounting evidence that atypical antipsychotics can be effective in addressing some of the factors that can make anorexia nervosa so challenging to treat.
Although there is no evidence from trials that atypicals show effectiveness in addressing the core path of anorexia, they do appear to make a difference in reducing anxiety and promoting sleep, Bermudez says. Also, atypicals appear to have an impact in addressing the phenomenon of “cognitive rigidity,” in which a patient's thought process is hijacked to such a degree that the prevailing mindset becomes one of, “I'd rather die than gain weight.”
“It's hard to get beyond that” in treatment, Bermudez says. The medications appear to create an opening for achieving a better balance between what the patient prefers to do and what she/he would be better off doing, he explains.
To medicate or not?
As with the addiction treatment field, there exists division within the eating disorders treatment community regarding the appropriateness of medication use for this population. Bermudez says there are plenty of examples of individuals who prescribe in a balanced fashion, those who tend to under-medicate, and those who tend to over-medicate.
“We want to come to the middle,” he says. “We want to use the science well.”
As medication treatments become more closely integrated into eating disorders care, professionals and programs will be having medication discussions with a much broader population than has been the case in the past, given the more diverse demographic being affected by eating disorders. “It becomes everyone's illness,” Bermudez says, now that more males, older adults, Hispanics, African-Americans, and even younger children become diagnosed with an eating disorder. “Families will have to accept that this is an option.”