Eating Disorders, ADHD (ADD) and Stimulant Medication

Written by Kathleen G. Nadeau, Ph.D.

The coexistence of eating disorders and ADHD has only recently begun to receive recognition in the eating disorders community. Just as has been the case in the addiction community, there remains a strong reluctance in the eating disorders community to believe that the prescription of stimulant medication is appropriate and medically safe for individuals that struggle with issues of either addiction or eating disorders.

In both the eating disorders and the addictions communities, there is a fear that stimulant medication will be misused or abused. Among eating disorders specialists, there is a common belief that stimulant medication will be used as an appetite suppressant rather than used appropriately to address ADHD symptoms. While medication mis-use or abuse is a possibility that should always be considered, it is important that clinicians treating clients with eating disorders become fully educated in the diagnosis and treatment of ADHD (ADD) so that they can better understand that appropriate use of stimulant medication can help the individual with eating disorders.

Psychostimulants, when used appropriately, can strengthen impulse control, helping the client to resist patterns of impulsive binge eating; psychostimulants can also be a very effective part of a comprehensive treatment plan that assists those with eating disorders to become better able to plan ahead so that they can engage in healthy daily eating patterns, and head on a path toward healthy eating and healthy daily living.

At present, Fluoxetine (Prozac) is the only medication approved by the U.S. Food and Drug Administration for treating bulimia. Researchers propose that Fluoxetine can help issues of anxiety and depression and appears to help reduce patterns of binge-eating and purging. It also appears to reduce relapses (Arnold, et al, 2002; Romano, et al, 2002). Many women that struggle with eating disorders report using sugar and refined carbohydrates as “self-medication” that temporarily calms them and reduces their anxiety. Thus, it makes sense that Fluoxetine, which reduces anxiety and depression would reduce the anxiety or depression-driven binge eating episodes.

It is important to understand that other processes are involved when women with ADHD struggle with eating disorders. Their ADHD makes meal planning difficult; their ADHD makes impulse control difficult; and it is stimulant medication that is most effective in addressing many of the executive functioning issues associated with ADHD such as impulse control, habit development, planning and follow-through ability.

In 2002, Lance Levy, an eating disorders specialist in Toronto, Ontario, wrote that while a number of medications are effective in Binge Eating Disorder, including Prozac, Zoloft, Paxil and Effexor (Levy, 2002, p. 102) he found that at least 25% of his patients that were more chronically and seriously obese had an attention problem underlying their inability to control their weight. Levy wrote that such clients must be treated pharmacologically for ADHD because he found that binge eating and food cravings, especially in the later part of the day and evening, did not respond to Prozac or dietary measures. In those cases where ADHD was the true diagnosis, these symptoms responded to ADHD medication.

Carolyn Dukarm, MD, in her 2006 book on eating disorders and ADHD, Pieces of a Puzzle, concurs with Lance Levy. She writes that management of eating disorders with SSRI’s such as Prozac (Fluoxetine) resulted in only partial improvement. By contrast, she found that stimulant medication treated both ADHD and eating disorders effectively, in many cases improving attention and mood, while decreasing obsessive thinking about food. In some cases, she found that women treated with stimulants showed “complete resolution of binge eating and purging” patterns (p. 77).

In patients with eating disorders and ADD, Dukarm writes that stimulants have been shown to:

decrease impulsive binge eating and purging
decrease obsessive thoughts about food
improve ability to follow a meal plan

At the Chesapeake Center, we work with clients to develop an ADHD-friendly approach to developing meal plans and healthy daily habits in a comprehensive approach that combines structured counseling/coaching with stimulant medication, as appropriate.

References:

Arnold LM, McElroy SL, Hudson JI, Wegele JA, Bennet AJ, Kreck PE Jr. A placebo-controlled

randomized trial of fluoxetine in the treatment of binge-eating disorder. Journal of Clinical Psychiatry, 2002; 63:1028-1033.

Dukarm, Carolyn Piver Pieces of a Puzzle: The Linkg Between Eating Disorders and ADD. Washington,

DC: Advantage Books, 2006.

Levy, Lance Conquering Obesity. Toronto, Ontario: Key Porter Books, 2002.p. 103-4.

Romano SJ, Halmi KJ, Sarkar NP, Koke SC, Lee JS. A placebo-controlled study of fluoxetine in

continued treatment of bulimia nervosa after successful acute fluoxetine treatment. Americ

an Journal of Psychiatry, Jan. 2002; 151(9): 96-102.

http://www.nimh.nih.gov/health/publications/eating-disorders/complete-index.shtml#pub2