Eating Disorders: Binge Eating (cont.)
Member: Do antidepressants help reduce episodes of binging? How do you know when it's time to try an antidepressant?
Fairburn: Another good question. One type of binge eating problem is called bulimia nervosa. People with this problem may benefit from antidepressant drugs. It has been shown that these drugs reduce their frequency of binge eating (and purging), although not many people stop altogether. The beneficial effects of antidepressant drugs in bulimia happen whether or not one is depressed in mood -- in other words, one does not need to feel depressed to necessarily benefit.
It must be added that not much is known about how long the beneficial effect of antidepressant drugs last in terms of their effect on binge eating. In contrast, it is well established that the effects of the two psychotherapies that I mentioned earlier are, in most cases, lasting.
Member: How readily will doctors use antidepressants if you present them with the evidence of a binge eating disorder?
Fairburn: If you present doctors with evidence that you have bulimia nervosa -- that is, you binge eat and purge afterwards -- then many doctors will readily prescribe antidepressant medication, since their effect on bulimia nervosa is well known.
Member: I binge but do not purge.
Fairburn: As regards other binge eating problems, then it is far less clear cut that antidepressants are helpful. Therefore, it is reasonable for doctors to have reservations about prescribing/recommending antidepressant medication in this instance.
Member: How do you feel about appetite-suppressing supplements and medications to prevent binges?
Fairburn: There is no evidence at all to support the use of appetite suppressants in the treatment of bulimia. There is a little evidence to support their use with other binge eating problems, but it really is a very little bit of evidence. Personally, I would not recommend taking them.
Member: I heard that dieting only makes binge eating worse because you try something new, fail, and then want to eat again to make yourself feel better. Is that true?
Fairburn: Your statement is partially true. For many people, dieting makes their binge eating worse, but not for the reason you say. The reason that this happens seems to be that dieting creates craving for the foods one is avoiding. This is the reason why people often binge on the very foods they are avoiding. In addition, if one is dieting very strictly, then there are physiological pressures that are making one binge.
Member: So, what should a binge eater do that is dieting? Just stop dieting and bring any type of food back into the house? I'm scared to stop "dieting" because I'm afraid I'll binge on those foods that I brought back into my life.
Fairburn: Your fears are understandable, and reasonable. It is difficult to do this. Again, I would recommend following one of the evidence-based self-help programs that explain how to do this step by step. You will find that they help you do this gradually in a systematic way, so that you don't become unstuck.
Member: What are the evidence-based self-help programs? Where do I find these programs?
Fairburn: There are three evidence-based books, but only one is published in the U.S. It is called Overcoming Binge Eating and is a paperback published by Gilford Press in New York. I'm afraid that I am the author. It can easily be obtained by any bookseller. It was published in 1995. It has been tested in many research studies in the U.S. and elsewhere in the world.
Moderator: Thanks to Christopher Fairburn, MD for being our guest. For more information about binge eating problems and their causes, and to explore self-help treatment, read Overcoming Binge Eating, by Christopher G. Fairburn, MD.
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