How SSRI’s Can Help Treat Eating Disorders

Selective Serotonin Reuptake Inhibitors, more commonly referred to as SSRIs, are some of the most commonly known psychiatric medications. Medications that fall under the drug family of SSRIs are “often used as first-line pharmacotherapy for depression and numerous other psychiatric disorders due to their safety, efficacy, and tolerability [1].”

You may hear about SSRIs in relation to eating disorder treatment for these reasons alone, as depressive symptoms commonly co-occur with eating disorder behaviors and beliefs.

It is helpful to inform oneself if considering any psychotropic medication. Read on if you are curious about the role SSRIS might play in the eating disorder treatment of you or someone you love.

What Are SSRIs?

As their name describes, SSRIs work through “inhibiting the reuptake of serotonin, thereby increasing serotonin activity [1].” For those that struggle with depression or other psychiatric disorders, serotonin activity can play a key role in their symptoms.

When compared with other antidepressant medications, SSRIs are unique in that they “have little effect on other neurotransmitters, such as dopamine or norepinephrine [1].”

Some commonly known SSRI medications as well as their brand names (in parenthesis) are:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Vilazodone (Viibryd) [2].

SSRIs & Eating Disorder Treatment

As mentioned above, SSRIs may commonly be prescribed to individuals with eating disorder diagnoses to treat their co-occurring diagnoses. Eating disorders have many contributing factors and causes, however, research has long-indicated that one of the most common mediating factors are co-occurring mental illnesses, the most common being Major Depressive Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), substance use disorders, and numerous personality disorder diagnoses.

Whether the mental health diagnoses or the eating disorder came first, they are often interconnected, meaning that reduction of other disorder symptoms will likely contribute to reduction in eating disorder symptoms.

As far as effectiveness, research has indicated that SSRI use with individuals with eating disorders can be effective. One study gave women receiving inpatient eating disorder treatment for anorexia nervosa – restricting type either fluoxetine or a placebo and found that “women receiving fluoxetine had a significantly lower rate of relapse than those treated with placebo [3].”

Further, Fluoxetine has been approved by the FDA specifically for treating bulimia nervosa as numerous studies have found it effective in reducing bulimic symptoms [4]. “Reviewers suggest that fluoxetine should be the first line agent for BN [4].” Interestingly, the impact of Fluoxetine on bulimia behaviors does not seem to rely solely on co-occurring depressive symptoms, as both those with and without depression show eating disorder symptom improvement after taking it [4].

Studies have also found that Citalopram (Celexa) “appeared to improve depression, obsessive -compulsive symptoms, impulsiveness and trait-anger,” all of which can contribute to eating disorder development or mediation [3]. Particularly interesting is the success in reducing impulsiveness, as these can be particularly contributive to bulimia nervosa and binge eating disorder. Obsessive-compulsive symptoms are also commonly present in anorexia nervosa symptoms. Citalopram has also been found specifically to help in reduction of body dissatisfaction, which is common in eating disorders [5].

The SSRI Sertraline (Zoloft) is also helpful in reducing perfectionist tendencies which are also common in those with eating disorders, particularly anorexia nervosa [5].

It is worth noting that these impacts are less evident in children and adolescents with eating disorders and that “given the limited evidence to support their use, SSRIs should be reserved for treating comorbid depression or anxiety in pediatric patients with AN who have been weight-restored [3].”

Side Effects of SSRIs

While SSRIs are commonly prescribed and recommended, it is impossible to add and alter chemicals into one’s system and not experience some side effects. While it is not know how each individual will respond to any medication, the following are common side effects of SSRI medications:

• “Sexual dysfunction,
• Sleep disturbances,
• Weight changes,
• Anxiety,
• Dizziness,
• Xerostomia (dry mouth),
• Headache,
• Gastrointestinal distress
• Increased risk of suicidality among pediatric and young adult (up to age 25) populations [1].”

There is no magical cure-all for any mental illness. There is no pill that can take away all of the emotional dysregulation, trauma responses, and maladaptive behaviors. Even so, it is okay to take medications with the hope that they will supplement your therapeutic, medical, and nutritional efforts and contribute to your long-term eating disorder recovery.

Resources

[1] Chu, A., Wadhwa, R. (2021). Selective serotonin reuptake inhibitors. StatPearls Publishing.

[2] Unknown (2014). Selective serotonin reuptake inhibitors (SSRIs) information. Federal Food and Drug Administration. Retrieved from https://www.fda.gov/drugs/information-drug-class/selective-serotonin-reuptake-inhibitors-ssris-information.

[3] Flament, M. F., Bissada, H., Spettigue, W. (2012). Evidence-based pharmacotherapy of eating disorders. International Journal of Neuropsychopharmacology, 15.

[4] Couturier, J., Lock, J. (2007). A review of medication use for children and adolescents with eating disorders. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 16:4.

Author: Margot Rittenhouse, MS, LPC, NCC
Page Last Reviewed on April 7, 2022, and Updated By: Jacquelyn Ekern, MS, LPC