Eating Disorders and 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.”
Especially for bulimia and binge eating, a combination of CBT and medication may work best. In a study of 30 patients with binge eating disorder, for instance, researchers at Sacco Hospital in Milan, Italy, found that those receiving both CBT and a combination of drugs, including setraline and Topamax, reduced their bingeing behaviors and lost weight.
Tailoring treatments to patients is essential. “Some people are receptive to medication,” Sacker says. “Others aren’t. Some people do well with nutritional counseling. Others need intensive counseling to change the way they think about eating and food. Treatment is often a matter of trial and error.” Indeed, researchers are testing a variety of cognitive behavioral therapies specifically designed for eating disorders.
Finding Help for Eating Disorders and Depression
There is no magic bullet for treating eating disorders coupled with depression. Even intensive research treatment programs have a high drop rate. Patients who do well for a period of time often relapse.
“Still, there’s a lot that we can do to treat underlying depression and change the way people think about themselves and their relationship to food,” Sacker says. The first step is finding a psychiatrist or psychologist with extensive experience in treating eating disorders, experts agree. After that, success depends on a patient’s willingness to change.