Do Antidepressants Treat Eating Disorders?
Understanding the Role of Medication in Eating Disorder Recovery
Eating disorders are complex mental health conditions influenced by psychological, biological, social, and environmental factors. While therapy and nutritional rehabilitation are often central to treatment, many people wonder: can antidepressants help treat an eating disorder?
The short answer is: sometimes — but not alone. Antidepressants can play a valuable role in treating certain eating disorders and co-occurring conditions, but they are not a standalone cure. Understanding when and how medication is used in eating disorder treatment can help individuals and families make informed, evidence-based decisions.
This article explores the types of eating disorders that may respond to antidepressants, the benefits and limitations of medication, and the importance of integrated, multidisciplinary care.
Antidepressants and the Brain
Antidepressants are medications designed to help regulate mood by altering neurotransmitter activity in the brain — most commonly serotonin, norepinephrine, and dopamine. These neurotransmitters play roles not only in mood regulation, but also in:
Appetite and satiety
Anxiety and compulsive behaviors
Sleep and energy
Cognitive flexibility
Because eating disorders often involve disruptions in these systems, targeted medication can help alleviate certain symptoms, especially when combined with therapy and nutritional support.
Which Eating Disorders May Respond to Antidepressants?
1. Bulimia Nervosa
Antidepressants are most clearly effective in bulimia nervosa (BN), particularly in reducing binge-purge behaviors and improving mood.
Fluoxetine (Prozac), an SSRI, is FDA-approved for the treatment of bulimia at a higher-than-usual dose (60 mg daily).
Studies show that fluoxetine can significantly reduce bingeing and purging episodes, even in the absence of comorbid depression (Goldbloom et al., 1997; Mitchell et al., 2002).
SSRIs may also help regulate obsessive thoughts about food and body image and improve distress tolerance.
2. Binge Eating Disorder (BED)
SSRIs, SNRIs, and some atypical antidepressants have shown efficacy in treating binge eating disorder, especially when mood disorders are present.
Fluoxetine, sertraline, and escitalopram have been associated with reduced binge frequency and improvements in emotional eating (Arnold et al., 2002).
Lisdexamfetamine (Vyvanse) is the only FDA-approved medication specifically for BED, but certain antidepressants may be prescribed off-label for their anti-compulsive and mood-stabilizing effects.
3. Anorexia Nervosa
The use of antidepressants in anorexia nervosa (AN) is more controversial and less effective overall.
Most studies show limited benefit from SSRIs in individuals who are severely underweight, as malnutrition may impair the brain’s ability to process medication (Attia et al., 1998).
Antidepressants may be more effective after weight restoration, particularly if depression, anxiety, or OCD symptoms persist.
Low-dose atypical antipsychotics (like olanzapine) are sometimes used to reduce rigidity, anxiety, and distress during weight gain, but this is not the same as traditional antidepressant therapy.
What Antidepressants Can (and Can’t) Do
What They Can Do:
Reduce symptoms of co-occurring depression and anxiety, which are common in eating disorders
Help interrupt compulsive behaviors, particularly in bulimia and BED
Improve emotional regulation, especially when mood swings or panic fuel disordered eating
Enhance therapy engagement by reducing intrusive thoughts or low motivation
What They Cannot Do:
Replace nutritional rehabilitation or weight restoration
Cure the underlying psychological drivers of an eating disorder (e.g., trauma, perfectionism, identity)
Work effectively in cases of severe malnutrition, where brain chemistry is already disrupted
Eliminate the need for psychotherapy, medical monitoring, and nutritional counseling
Important Considerations Before Starting Antidepressants
Medication is not a quick fix. It may take 4–6 weeks to notice effects, and adjustments may be needed.
Not every medication works for every person. Side effects, genetic factors, and personal history matter.
Medical monitoring is essential. Some antidepressants can affect heart rate, blood pressure, or appetite, which may already be compromised in eating disorder patients.
Collaboration is key. Antidepressants work best as part of a multidisciplinary team approach involving therapists, dietitians, and medical providers.
When Medication May Be Especially Helpful
Antidepressants are more likely to be beneficial in eating disorder recovery if you:
Have co-occurring depression, anxiety, OCD, or PTSD
Struggle with rumination or obsessive thoughts
Are receiving therapy and need additional support for mood symptoms
Have achieved some nutritional stability but continue to experience mood dysregulation
Have a history of antidepressant response in previous mental health treatment
In adolescent populations, careful evaluation is necessary, and parental involvement is crucial when initiating medication.
Risks and Side Effects
Like all medications, antidepressants come with potential side effects. These may include:
Nausea, headaches, or gastrointestinal distress
Sleep changes
Weight changes (varies by individual and medication)
Emotional blunting or increased agitation in some cases
Rare but serious risk of suicidal ideation, especially in adolescents (requires close monitoring)
It's essential to weigh the benefits against risks and maintain regular check-ins with a prescriber trained in eating disorder care.
Final Thought
Antidepressants are not a cure for eating disorders — but for many, they are a helpful support tool that can reduce symptoms, improve quality of life, and increase the effectiveness of therapy and nutritional recovery.
If you're considering medication, talk to your provider about your full symptom profile, medical history, and goals for recovery. With the right plan in place, antidepressants can be one of several powerful tools in the journey toward healing.
References
Attia, E., Haiman, C., Walsh, B. T., & Flater, S. R. (1998). Does fluoxetine augment the inpatient treatment of anorexia nervosa? American Journal of Psychiatry, 155(4), 548–551.
Goldbloom, D. S., Garfinkel, P. E., & Remick, R. A. (1997). Fluoxetine in the treatment of bulimia nervosa: A multicenter, placebo-controlled, double-blind trial. Archives of General Psychiatry, 54(4), 377–383.
Mitchell, J. E., Devlin, M. J., De Zwaan, M., Crow, S., & Peterson, C. B. (2002). Bupropion and fluoxetine in the treatment of bulimia nervosa. International Journal of Eating Disorders, 32(2), 127–138.
Arnold, L. M., McElroy, S. L., Hudson, J. I., et al. (2002). A placebo-controlled, randomized trial of fluoxetine in the treatment of binge-eating disorder. Journal of Clinical Psychiatry, 63(11), 1028–1033.
Kaye, W. H., Bulik, C. M., Thornton, L., Barbarich, N., & Masters, K. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161(12), 2215–2221.
