Antidepressants for eating disorders

Antidepressants and other psychiatric medication are often prescribed during treatment for eating disorders. Deciding to use medication to support your child’s recovery is deeply personal and individual. If your child’s psychiatrist is recommending medication, you can ask the following questions:

• What are the symptoms you are hoping to treat?
• Why are you choosing this specific medication and dosage?
• What is the evidence of this medication being effective in my child’s specific situation?
• How long do you anticipate my child will need to be on this medication?
• How will you evaluate whether the medication is successful?
• Do you have a plan to eventually taper or reduce my child’s prescription?
• What should I look for at home and when and how should I report troubling side effects?
• Is there anything my child should not do when taking this medication?

When facing a big decision about whether medication will be helpful it’s very tempting to seek input from friends, family members, and even strangers on the Internet. You also probably already have strong opinions about whether psychiatric medicines are good or bad, helpful or unhelpful. Use caution when jumping to conclusions or seeking advice from anyone who is not either a psychiatrist and/or directly involved in treating your child.

There is a lot of stigma about psychiatric drugs, and while I do believe in being cautious and thoughtful about medication plans, I recommend you seek scientific evidence rather than opinions and ideas from individuals who mean well but are not qualified to give medical advice. 

If you do conduct your own research, keep the following guidelines in mind: 

Check your sources

It’s easier to read a blogger’s opinion about medication, but consider whether they are telling you a personal account or referencing scientific peer-reviewed research studies from professional journals. These studies have undergone rigorous evaluation by experts and are thus more likely to be credible and accurate. Lay people mean well and are much more engaging than scientific reports, but they are also very likely to misinterpret or misunderstand key elements of the original research. Whenever possible, find the original research and take a look at it yourself. Then ask your child’s psychiatrist for their opinion.

Check your biases

All humans have something called “confirmation bias,” which means we seek to support our existing beliefs. This can be dangerous on the internet, where we can go down rabbit holes that support our beliefs without considering the alternative perspectives. Evaluating something scientifically begins with knowing your biases and challenging them. So if you believe that medication for ADHD is dangerous, begin your research by seeking confirmation that it’s useful. Simply taking this step will help you avoid the confirmation bias trap and give you a more complete view of the potential benefits and drawbacks.

Assume a mixed prognosis

Almost nothing in psychiatric medicine is clear cut. Every medicine has its pros and cons. Go into your research assuming that even a “magic bullet” may not work for your individual child. Medicine may work like magic, it may help a little, or it may not help at all. You really won’t know until you see it in action. Knowing this in advance can help you take a more scientific approach to medication.

Beware of personal anecdotes

Every medication will have message boards on which people praise the medicine, calling it a lifesaver, and message boards on which people bash the medicine, calling it a dangerous mistake. These personal anecdotes are all individual people who have their own unique experience with medication. I found these message boards when I was considering a particular medication and it completely freaked me out. But when I stepped back, I noticed that there were just as many people singing its praises as there were people saying it was terrible and useless. The feedback from individual people was very mixed. So I went back to the peer-reviewed journals to get the evidence and help me make the best possible decision at the time. 

Some data on antidepressants in eating disorder treatment

The data on antidepressants for eating disorder treatment is mixed. For example, a study in 2008 found no statistically significant differences between antidepressants and placebo for the frequency of binge-eating episodes, but a study in 2022 found significant reduction in binge frequency with antidepressants. A 2006 study concluded there was not enough evidence to draw a definite conclusion regarding antidepressant use for acute anorexia. And a study in 2003 found that antidepressants were clinically effective for bulimia but also had a higher rate of dropout from the study, suggesting there were other side effects.

One thing to think about is that the placebo effect is real. Just because an antidepressant doesn’t perform better than a placebo doesn’t mean it’s not working at all. Because placebos work! So consider that sometimes when someone is in pain, there is tremendous relief in being prescribed medicine to help. And if a sugar pill works as well as an antidepressant, that means either one can help.

Also, your child’s psychiatrist may prescribe an antidepressant not for the eating disorder symptoms themselves, but for other conditions. Antidepressants are frequently prescribed for other conditions that co-occur with eating disorders, including depression, anxiety, ADHD, and OCD.

Additionally, keep in mind that many prescriptions are short-term, used to help a person get through the worst of their depression. Meanwhile, a therapist can work with your child on anti-depression strategies like movement, emotional regulation, and sleep.

The bottom line is that you should consult with your child’s psychiatrist and make a personal decision based on their advice.

Other options

Depression is a serious condition that must be taken seriously. The question is not whether to treat depression but how to treat it: with or without medication. Your child may benefit from antidepressants to get through this stage of their recovery. That absolutely may be the best decision right now. But at the same time, consider the power of lifestyle influences on depression. Lifestyle changes that are known to reduce symptoms of depression, often at higher rates than antidepressant medication, include:

• Sleep hygiene
• Emotional regulation skills
• Exercise
• Close family connections
• Belonging to social groups
• Meaning and purpose

Also, don’t underestimate the impact your own mental health can have on your child’s mental health. If your child is in eating disorder treatment, it will help if you pursue therapy or coaching as well. This is a great way to reflect on the patterns in your family and how your behavior impacts how your kids feel. Such self-reflection can have a huge impact on how your child feels. Therapy is not a punishment for being a bad parent. It’s a way for you to continue to learn and grow so you can meet your child’s needs and remain close even as they face their own mental health issues.

See Our Eating Disorder Treatment Guide For Parents