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Bipolar Disorder & Bulimia: Is the Medication Right for Me?
Of those who struggle with bipolar disorder, 14% also have a co-occurring eating disorder [1]. Bipolar disorder alone can be challenging to manage, and it can require daily monitoring of symptoms and behaviors. When coupled with bulimia nervosa (BN), it can be extremely complicated to cope with varying symptoms and without different levels of treatment.
1.5% of females within the general population struggle with bulimia and in those with bipolar, this number increases to almost 8% [1].
It can affect both the mind and body as often those with bulimia go through cycles of binging and purging through self-induced vomiting, laxative or diuretic abuse, overexercising or a mixture of all behaviors.
Signs and Symptoms of Bipolar and Bulimia
Some signs that accompany both bulimia and bipolar are irritability, moodiness, increased anxiety and obsessive-compulsive behaviors. This can complicate treatment and made it hard to diagnose either disorder when treating someone struggling with co-morbid issues.
In people who have both disorders, research has shown that the onset of symptoms occurs earlier with more frequent episodes of hypomania/mania and depression [1].
Typically when a person is seeking treatment, one of the most effective therapies is Cognitive Behavioral Therapy (CBT).
This allows individuals to be able to identify negative thought patterns, recognize emotions and reframe unhealthy thoughts and behaviors to create healthy ways to react to stressful situations.
Medication Management Options
In addition to therapies, separate medication treatments are also used to help with bipolar and bulimia. Antidepressants are typically used to treat bulimia to help decrease the desire to binge as well a the urge to purge.
It can be ineffective though for bipolar disorders due to its potential to increase mania and rapid cycling symptoms.
Lithium has not typically been used because it can cause toxicity and kidney damage. Mood stabilizers have also been shown to be ineffective in bulimia, like antidepressants, but can be a good option when trying to co-manage bipolar and bulimia.
Bipolar is known to have continually changing moods and can experience highs, or mania and lows, or depression [2]. It affects over 5% of American adults, and the onset is typically around 25 years of age.
Eating disorders, on the other hand, start younger around the age of puberty.
Medications That Are Being Used for Co-Morbid Diagnosis
Lithium has been in trial studies on eating disorder and bipolar effects and is being shown to have some positive results in the comorbid diagnosis [3]. Lithium has shown to reduce bulimic episodes within eight weeks of medication treatment.
Medications for bipolar such as valproate, risperidone, has been shown to be beneficial with acute mania episodes. Valproate, however, has been shown to be effective in those with both a bipolar and bulimia diagnosis but has also shown to increase binge eating [3]
Further pharmacological studies have shown effectiveness with topiramate, which decreases at least one binge-purge episode in those with the comorbid diagnosis.
There are mixed reviews on the response to antidepressants with those struggling with bipolar disorder. It can either increase symptoms or may require additional mood stabilizer medication treatment to get a positive response.
As with bipolar medications, antidepressants also have mixed reviews when used with eating disorders. Many are useful with bulimia, but it coupled with bipolar, it can worsen the bipolar symptoms and then trigger an eating disorder symptom response.
Medication management can be useful in treating some symptoms but while taking the medications a person needs to be carefully monitored by their physician or psychiatrist.
Typically most individuals who struggle with bipolar and bulimia require a combination of medicines to treat both disorders.
Educating Yourself on the Best Treatment
Knowing if medication management is right for you is only something you can personally decide. It is essential to go over the options with your treatment team. Knowing what medications are available, what symptoms may arise or side effects can occur can help you make the best-educated decision.
Often with medication, bipolar symptoms can stabilize, and a person can feel an increased physical and emotional well-being. With the bipolar symptoms steadying, the bulimia may start to worsen, as often both disorders will become active once the other disorder is under control.
With further medications, both disorders can have a reduction in symptoms, but it may take a while to adjust.
Understanding the various medications used to treat bipolar and bulimia can help decide on the best treatment for your recovery process.
Looking into medication variations, side effects, and effectiveness of the medication can help you discuss the best course of medication management.
With medication also requires individual therapy to address patterns of thoughts and behaviors that accompany your disorders.
Working with your treatment team to address underlying issues to the eating disorder, and gaining coping skills to help manage the bipolar can aid in the recovery process. Medication alone is typically not the only path to recovery.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
References:
[1] When Bipolar Disorder Meets Bulimia. (n.d.). Retrieved August 19, 2017, from https://blogs.psychcentral.com/bipolar-laid-bare/2017/03/when-bipolar-disorder-meets-bulimia/[2] High Rate of Eating Disorders in Bipolar Patients. (2015, October 06). Retrieved August 19, 2017, from https://psychcentral.com/news/2010/08/05/high-rate-of-eating-disorders-in-bipolar-patients/16424.html
[3] P. (n.d.). Comorbidity of Bipolar Disorder and Eating Disorders: What Can the Clinician Do? Retrieved August 19, 2017, from http://primarypsychiatry.com/comorbidity-of-bipolar-disorder-and-eating-disorders-what-can-the-clinician-do/
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on November 11, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on November 11, 2017.
Published on EatingDisorderHope.com
