Psychopharmacological treatments in eating disorders & comorbid conditions

The prevalence of eating disorders (ED) has been increasing around the globe and among the minority populations in industrialized countries along spread of Western life style and cultural values emphasizing physical appearance and fashion behavior. The Internet and new social media tools such as Facebook, Twitter, Instagram, etc. would likely exacerbate negative impact of media on dieting behavior, body image, orthorexia, etc. and relationship of individuals with food overall. From another perspective video game, Internet, and other screen based addictions, gambling, and compulsive buying share some characteristics with ED in terms of behavioral addictive nature. It has been difficult to develop and test efficacy of biological agents, and seek Federal Drug Administration (FDA) approval for them due to complicated nature of eating disorders, limited diagnostic criteria, and concurrent conditions. The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has brought significant changes and specificity to classification of eating disorders. Despite the lifetime prevalence of ED is estimated to reach 5.9% among women (2), şuoxetine still remains to be only FDA approved medication for treatment of an ED. Although the evidence for pharmacological interventions to treat ED has been limited, most ED patients end up needing treatment with various psychopharmacological agents due to co-occurring mood, anxiety, trauma, and substance use disorders (3). Hence we will review psychopharmacological treatment options for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and common comorbid conditions including major depressive, bipolar, posttraumatic, generalized anxiety, obsessive compulsive disorders, and alcohol use disorder. Since EDs have high rates of comorbid conditions in addition to sharing similar characteristics with behavioral addictions, it is important for clinicians to be aware of psychopharmacological agents that can be effective in treating EDs, even they are not FDA approved. Furthermore investigating new agents, that would be effective in treating ED, might result in potentially beneficial agents for treatment of concurrent conditions and behavioral addictions.