Which antidepressant would you question if ordered for a patient diagnosed with anorexia?

Question

Think about the main issue with any patient diagnosed with anorexia. What is it? What are we trying promote? What are we trying to prevent? Think physiological needs. So if this antidepressant was ordered why would you want to call the provider? It’s because of one of the main side effects to this antidepressant which we are trying to prevent.

What is the medication? Explain your answer.

Answer 1

DISCLAIMER: The following answer is not to be taken as medical advice. If you or someone you know is struggling with anorexia, please contact your local medical provider. 

TLDR: Patients with anorexia nervosa are prone to seizures. The antidepressant bupropion promotes seizures in this patient population. Olanzapine has some evidence as a better option due to weight gain and symptom management.

Treatment of anorexia nervosa should be multifactorial and incorporate components of therapy with a trained psychologist and a tailored pharmacotherapy regimen. As the question suggests, managing anorexia nervosa with antidepressants can be challenging and dangerous to the patient if handled incorrectly. It is important to remember this patient population is severely malnourished and likely has electrolyte abnormalities. Clinically this means that anorexia patients are prone to seizures. 

A common provider mistake is prescribing bupropion, an antidepressant, to manage anorexia. This is a mistake because bupropion lowers the seizure threshold for anorexic patients promoting additional seizures. 

A better management choice for patients struggling with anorexia nervosa would be low-dose olanzapine. Olanzapine is an antipsychotic medication that has been shown in some trials to promote weight gain in patients recovering from anorexia nervosa.