Anorexia nervosa medication: What is the best anorexia treatment?

Key Points

• Anorexia nervosa is an eating disorder with severe health consequences.
• There is no one medication to "cure" anorexia, but different drugs can help manage co-existing physical health conditions and psychiatric disorders.
• These may include antidepressants, atypical antipsychotics, hormone therapy, nutritional supplements, and other necessary medicines.
• The best anorexia nervosa treatment is a collaborative team of eating disorder experts who develop personalized treatment plans depending on the unique needs of each person.

Anorexia nervosa is an eating disorder characterized by extreme calorie restriction, an intense fear of gaining weight, and compensatory behaviors like excessive exercise. 

While certain medications can play a supportive role in addressing co-existing medical complications and mental health conditions, anorexia cannot be treated with a single medication because it is a highly complex mental health condition. 

Dietitians may also provide ongoing nutritional counseling and support throughout recovery.

Does medication work for anorexia treatment?

According to Registered Dietitian Rita Faycurry, RD, "Research shows that nutritional rehabilitation combined with psychotherapy is more effective when treating anorexia than medication. However, people with anorexia are often severely underweight, suffer from a host of medical issues, and have co-existing psychiatric disorders that may benefit from medications."

Since people with anorexia are often malnourished, the first goal of anorexia treatment is weight restoration. This can be extremely challenging because, at its core, anorexia is driven by an intense fear of weight gain. There is a strong chance that individuals with anorexia may refuse to eat or follow a nutrition plan designed to help them gain weight. Plus, many medications simply don't work when someone is malnourished or dehydrated.

Medication for people with anorexia is usually prescribed for weight gain and to treat co-existing psychiatric disorders like anxiety, depression, or obsessive-compulsive disorder (OCD).

Here's an overview of common medications used during anorexia nervosa treatment. Please consult a medical professional or psychiatrist before starting a medication regimen or making changes to an existing one.

Antidepressant medications for anorexia nervosa treatment

Fluoxetine (Prozac) is commonly prescribed to treat depression and OCD which are conditions commonly found in people with anorexia. While Prozac may help improve a person's quality of life by alleviating symptoms of mental disorders, it does not help with weight gain and anorexia itself.

SSRIs

Fluoxetine is part of a group of antidepressant medications called selective serotonin reuptake inhibitors or SSRIs. Other common drugs in this category are Sertraline (Zoloft), Citalopram (Celexa), and Escitalopram (Lexapro). Zoloft has been shown to help reduce perfectionist tendencies that are usually present in those with eating disorders.

SSRIs can also help with depressive symptoms after weight restoration. This could support recovery efforts and help maintain a healthy body weight.

SNRIs

Serotonin norepinephrine reuptake inhibitors (SNRIs) are another class of antidepressants that may be prescribed for people with anorexia. They do not promote weight gain but can help with co-existing obsessive-compulsive problems.

Atypical antipsychotics

Atypical antipsychotics are medications commonly used to reduce mood swings, major depressive disorder, schizophrenia, OCD, and other mood disorders. These drugs usually have fewer and milder side effects than typical antipsychotics.

Olanzapine (Zyprexa) is an atypical antipsychotic that may help with a slight increase in weight. However, there isn't enough data to prove it. Olanzapine works by increasing appetite, but people with anorexia already feel hunger. The real challenge is getting them to overcome their intense fear of feeding.

Faycurry RD notes, "Although people with anorexia battle severe body image issues and have heavily distorted views of their eating habits, weight, and health, they may not always respond well to antipsychotic medications." All medications must be accompanied by medical nutrition therapy (MNT) and psychotherapy to improve physical and psychological symptoms of eating disorders."

Benzodiazepines

Benzodiazepines are known as depressants; they are primarily indicated to treat anxiety, extreme stress, and insomnia and are used as sedatives before medical procedures. Some well-known medications are Ativan, Xanax, Valium, and Klonopin.

Benzodiazepines are highly addictive and carry a high risk of dependence, particularly for people with eating disorders. This is because both conditions share common factors like anxiety, depression, low self-esteem, and genetics. Due to these risks, the US FDA advises trying other therapies first. If benzodiazepines are used, they should be at the lowest dose and for a short time.

Other medications to treat medical complications of anorexia

Typically, anorexia nervosa can lead to severe health consequences, including:

• High risk of fractures due to osteopenia or osteoporosis (weak bones)
• Anemia
• Muscle weakness
• Fatigue
• Digestive issues from starvation and laxative misuse, like chronic constipation
• Low blood pressure
• Cardiovascular issues
• Delayed puberty, skipped periods, and infertility
• Cognitive issues
• Organ damage.

To improve bone health, some doctors may prescribe birth control pills, but research has shown that they are ineffective. The best way to restore bone density is to encourage weight gain. Nutritional support like Vitamin D and Calcium supplements may also help.

What is the best treatment for eating disorders?

Anorexia can be fatal and has a high rate of relapse, but recovery is possible. Eating disorder treatment is best managed by a team of eating disorder specialists, including doctors, psychotherapists, and registered dietitians (RDs).

Psychotherapy

Since anorexia, like other eating disorders, is a psychiatric disorder, talk therapy with a mental health professional is the standard of care. Cognitive Behavioral Therapy (CBT) is used to gradually help change eating habits and thoughts of self-harm and address social challenges during anorexia recovery.

Family-based therapy (FBT) also helps, particularly for adolescents with eating disorders. FBT specialists work with the entire family to learn about nutrition, healthy eating patterns, and how to support someone through anorexia treatment and recovery.

Nutrition therapy with registered dietitians (RDs)

Registered dietitians who specialize in eating disorders are a vital part of eating disorder treatment. They create personalized nutrition plans based on each individual's unique needs, help address malnutrition, support weight gain efforts, and offer ongoing motivation on the road to anorexia recovery.

Looking to help you or a loved one with anorexia? Fay helps you find anorexia treatment near you.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.