Navigating the Transition from Anorexia to Binge Eating: Medication Insights

Consultation for medication regarding anorexia and binge eating?

I was diagnosed with anorexia six months ago and have been taking 75 mg of Sertraline (Zoloft) four times a day.
Over the past two to three months, my weight has increased by 5 to 6 kilograms, but I have been experiencing frequent binge eating, especially with bread and desserts.
The binge eating episodes are becoming more frequent, and even when I try to avoid food due to hunger, I still end up binge eating.
My feelings of depression and suicidal thoughts have also intensified, and my emotions are quite unstable.
The Sertraline has indeed shown a significant improvement in my mood.

I would like to know if I can continue using Sertraline as a treatment for binge eating disorder.
I read that the dosage required for binge eating is usually higher, so can't I just increase the dosage of Sertraline? However, my doctor mentioned that four tablets is already the maximum dosage.
Does this mean I need to switch medications? Or is it because my weight is still considered too low that I am not classified as a binge eating disorder patient? Am I considered an anorexia patient, a binge eating disorder patient, or someone with alternating anorexia and binge eating? I feel like I have anorexia in terms of mindset but binge eating behavior, especially with bread and desserts, which feels like an addiction...
This contradiction is very painful.

SY, 20~29 year old female. Ask Date: 2016/12/14

Dr. Zhang Gengjia reply Psychiatry

Dear Sir/Madam,
Thank you for your message.
Based on your description, I can clearly sense the discomfort you are experiencing.
Cases of anorexia often accompany obsessive thoughts about weight control and may also involve compulsive behaviors such as self-induced vomiting.
Descriptions of obsessive-compulsive disorder (OCD) have appeared in classic literature, such as in Shakespeare's "Macbeth," where Lady Macbeth suffers from compulsive handwashing, leading to her torment and struggle.
Commonly reported compulsive behaviors include checking, washing, counting, asking questions, confessing, creating symmetry and order, and the need for complete correctness.
Obsessive thoughts and compulsive behaviors are often intertwined, as resisting obsessive thoughts can lead to corresponding compulsive actions (Kong Fan-Chung, 2000).
You mentioned being diagnosed with anorexia six months ago, and I can imagine the suffering you have endured during this time.
However, I must remind you that a BMI within a certain range is considered healthy, and a certain degree of weight gain may also be a sign of health.
Our hospital has established a special outpatient clinic for psychosomatic disorders to create a therapeutic environment that alleviates the suffering caused by anorexia.
We have outpatient registration hours from Monday to Friday, both in the morning and afternoon, with morning hours until 11:30 AM and afternoon hours until 4:30 PM.
The consultation phone number is 06-2795019 ext.
1106, 1107.
We welcome your visit and wish you good physical and mental health.
Sincerely,
Dr.
Chang Geng-Jia
Department of Psychiatry

Reply Date: 2016/12/14

More Info

Navigating the transition from anorexia to binge eating can be a complex and challenging journey, especially when it involves medication management. It sounds like you have been diagnosed with anorexia and have been taking 75 mg of the medication "Seroquel" (Quetiapine) daily, which has helped you gain some weight. However, you are now experiencing episodes of binge eating, particularly with sweets and bread, and you're feeling an increase in depressive thoughts and emotional fluctuations.

Firstly, it's important to understand that Seroquel is an atypical antipsychotic that is often used to treat mood disorders, including depression and anxiety. It can help stabilize mood and improve emotional regulation, which may explain the positive effects you've noticed. However, it is not specifically indicated for binge eating disorder (BED), and the treatment for BED often requires different approaches.

Binge eating disorder is characterized by recurrent episodes of eating large quantities of food, often quickly and to the point of discomfort, accompanied by feelings of loss of control during the binge episodes. It is crucial to differentiate between anorexia nervosa and binge eating disorder, as they are treated differently. Your current weight and the fact that you have a history of anorexia may complicate this diagnosis. It is possible to experience a pattern of alternating between restrictive eating (anorexia) and binge eating, which is sometimes referred to as "anorexia binge-purge subtype" or "binge eating disorder" depending on the frequency and severity of the binge episodes.

Regarding your concerns about medication, it is essential to communicate openly with your healthcare provider about your experiences with binge eating and the emotional distress you are facing. While Seroquel may have helped with mood stabilization, the dosage you are currently on is considered the maximum for many indications, and increasing the dose may not be advisable due to potential side effects and the risk of developing tolerance.

Your doctor may consider switching medications or adding another medication that is specifically indicated for binge eating disorder. Some options include selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, which has been shown to be effective in reducing binge eating episodes. Other medications, such as lisdexamfetamine or topiramate, have also been used in the treatment of BED.

It's also important to address the psychological aspects of your eating behaviors. Cognitive-behavioral therapy (CBT) is a well-established treatment for both anorexia and binge eating disorder. It can help you develop healthier coping mechanisms, address the underlying emotional issues, and create a more balanced relationship with food.

In summary, it is crucial to work closely with your healthcare provider to reassess your treatment plan. You may need to explore different medication options and therapeutic approaches to address both your binge eating and the emotional challenges you are facing. Remember, recovery is a journey, and seeking support from professionals who understand the complexities of eating disorders can make a significant difference in your healing process.

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