The prescribing of appetite-reducing medication to bulimics has recently caught my attention. Whereas I was originally on the fence about it, I am more leaning toward not doing this. I stumbled upon this while surfing a topic on We Bite Back about topiramate (Topamax) that had veered toward whether or not to give meds to help curb eating-disordered binging.

I don’t think any medication that causes substantial weight loss or gain should be used in early ED recovery unless absolutely necessary.
The medication of discussion was topiramate which is an anticonvulsant used in treating seizures & occasionally mood disorders.
Bipolar & seizure disorders are a brain condition with electrons misfiring, over firing & underfiring. This is not the case with bulimia, so it seems like this is an artificial cap on urge to binge. It’s not a physical appetite that bulimics are trying to fill.
An appetite-reducing medication is addressing the physical, not the mental.

It is basically neurological vs. psychological. Drugs like topiramate or baclofen (which is actually a muscle-relaxant)  have been used to help reduce the urge to binge, an appetite suppressant. Your first reaction may be that medication that reduces appetite is an absolute no-no for anyone with an eating disorder, but my own therapist has several clients that have taken baclofen for binge-urges.

But wait,  medications like topiramate are to treat neurological illnesses (bipolar disorder, epilepsy etc.) not psychological urges. The urge to binge is psychological, the hunger is not physical, yet a medication that reduces physical appetite is given to help a psychological hunger?

Flip the situation – then you’d give someone with depression with a loss of appetite & weight (not on purpose) a drug that increased appetite. Doesn’t it seem like you’re hitting the wrong place? Because the depression caused the appetite loss. Depression treatment, therapy, coping mechanisms, emotional & behavioral skills & etc. are worked on & the person begins to recover & appetite returns.
Unless maybe the weight loss was dangerous, or if the weight of a binge eater was well over the morbid obesity range & was also facing dangerous health risks, but in average cases it seems like this is adding a much unneeded medication.

In both cases, despite how different, the eating disturbances are caused by an underlying issue that must addressed first. You may say that it should be attacked on all levels, but the medication is not a practical long-term treatment.
It’s like giving alcoholics the medicine that makes you violently ill if you drink, it is not reliable. It’s a shortcut that is not worthwhile.

Depression on its own is difficult to address, as is deciding if it’s psychological or neurological.
But either way, the depression, coping issues, behavioral problems, emotional baggage & etc. must be addressed first as that is the cause of the psychological hunger.
And, giving a drug that reduces appetite to someone with an eating disorder is a potentially dangerous thing to do.

What if, you give a bulimic undergoing both psychological treatment for her binging & purging who with the medication & with the psych treatment has been free of the psychological urge to binge. But now her appetite is reacting to physical cues rather than emotional ones, the medicine is reducing her appetite which then causes weight loss, which then triggers an anorexic cycle, which then trigger a bulimic relapse.
This is theoretical of course, but it’s not unlikely scenario.

This needless dispense of medications ups the risk of side effects as well.
Besides, do we really need more meds thesedays?