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Eating Disorders and Depression

Treatment Approaches to Depression and Eating Disorders

Two very different approaches have been shown to help some patients. One approach is the use of antidepressant medications or mood stabilizers. In a 2001 study of 35 patients with anorexia who had managed to eat enough to achieve a healthy weight, for instance, the antidepressant Prozac (fluoxetine) was shown to reduce the risk of relapse.

For binge eating disorder, two different kinds of medications are sometimes prescribed by doctors -- antidepressants and an anticonvulsant drug called Topamax (topiramate). These drugs have been shown to reduce bingeing, either alone or in combination. Unfortunately, over time, many patients relapse.

Another approach is cognitive behavioral therapy, or CBT. The goal is to change the way people think about food and eating and encourage healthier eating behaviors. One CBT method is called dissonance therapy. People with eating disorders who have become obsessed with the idea that they must be extremely thin to be attractive are encouraged to reject this unattainable image in favor of a more realistic ideal. Studies show that this approach can significantly reduce symptoms of bulimia, especially bingeing and vomiting in some patients.

Researchers have also had success encouraging some patients to adopt healthier eating habits. This approach uses a combination of education about healthy food choices and techniques for monitoring change, such as keeping food diaries. When appropriate, patients are also encouraged to become more physically active. 

Evidence shows that CBT can be effective. In a 2003 study of 33 patients with anorexia nervosa, only 22% of who received CBT relapsed over the following year, compared to 53% of patients who received nutritional counseling only.

CBT has also been shown to help people control binge eating. In a study published in 2010, researchers at Wesleyan University in Connecticut tested an eight-session course of CBT in 123 patients with binge-eating disorders. The therapy helped patients restrain their binge eating behavior and reduced their symptoms of depression.

Tailoring Treatment to Your Needs

Which approach is best? Both medication and cognitive behavioral therapy have distinct advantages and disadvantages, experts say. Medication is easy to take. Its effects typically show up relatively quickly.

Cognitive behavioral therapy, on the other hand, may take longer to work. Most patients require three to six months of therapy, according to Lilenfeld. Some may need even more.  But CBT has the advantage of offering a more reliable long-lasting cure.

“When people stop taking medications, they are more likely to have a relapse than when they’ve done cognitive behavioral therapy,” Lilenfeld tells WebMD. That’s not surprising, she points out. “The problem with medication is that once you stop taking it, it’s gone. With CBT you can permanently change the way people perceive themselves and the world. That kind of perceptual change can be especially helpful with eating disorders combined with depression.”

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