![Eating Disorders in twitter6.png](https://files.peakd.com/file/peakd-hive/ebingo/23ynN5jSj2rEsE8BPqD5uGKcQW9nV8bUEphQrJu6i6MFqy7kucQZ8c9f9NyaBPjU5ZagT.png)
[Inkscape.org](Inkscape.org)


<blockquote class="twitter-tweet"><p lang="en" dir="ltr">Prozac bottle: used to treat depression and bulimia<br><br>me who is promia and not ready to recover: <a href="https://t.co/eOOUvyGnDK">pic.twitter.com/eOOUvyGnDK</a></p>— ୨୧ lapin ୨୧ (@sleepylapin222) <a href="https://twitter.com/sleepylapin222/status/1598485006715846658?ref_src=twsrc%5Etfw">December 2, 2022</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>



In the last post, we saw how:

- There are biopsychosocial factors that can lead to BN
- These two disorders are very similar but tend to differ in the way the patient present. Those who have AN tend to be lower than the weight for height in BMI while BN may have normal or increased weight for height.
- SSRIs are very effective for the binge and purging types of ED.


![](https://images.ecency.com/DQmZo4GohJJRnkv36mD5tKczBeJYkyvFJ9fyLrLR63kxwoh/eating_disorders_in_twitter5.png)
[Inkscape.org](Inkscape.org)



<blockquote class="twitter-tweet"><p lang="en" dir="ltr">It makes me sad when people don’t know the difference between bulimia and anorexia. I believe mental health should be a thing that is taught in schools, but instead it’s just an option.</p>— Rose (@rosehiptea25) <a href="https://twitter.com/rosehiptea25/status/1276346543302467584?ref_src=twsrc%5Etfw">June 26, 2020</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>







Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for four consecutive months. This month will be dedicated to Eating Disorders. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Schizophrenia.

In this post, we are looking at **Twitter posts**. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.

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![Vibes dimacations.png](https://files.peakd.com/file/peakd-hive/ebingo/23vsqueDeqMiXPMUbFQM6ReJsiU63MBTLZGStCb3FobcSrsf3qrdMZecHReN7Kv6GVC5L.png)

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**<center>Diagnostic and Clinical Features</center>**
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There are specific clinical features that point to BN the episodes are frequent and happen every week for 13 weeks, the patient tries to compensate for weight gain with drugs or by inducing vomiting or might engage in rigorous exercise or poor caloric diets, the weight of the patient is not in the class of low eight as seen in patients with AN, the patient is afraid of being fat and want to be thin by all cost.

The patient may have a formal history of AN, this is seen in close to 50% of those with BN. The patient first starts binging before they start vomiting.

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![Vibes dimacations.png](https://files.peakd.com/file/peakd-hive/ebingo/23vsqueDeqMiXPMUbFQM6ReJsiU63MBTLZGStCb3FobcSrsf3qrdMZecHReN7Kv6GVC5L.png)

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# <center>Prozac in Eating Disorders (Reaction post)</center> 
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![image.png](https://files.peakd.com/file/peakd-hive/ebingo/AK59oTTfFC8bABGknKgjo8ZaJvHgPse4EfxCiLnsbsv88xue4SiVfDQj6PSv1Qh.png)




[Source](https://www.freepik.com/free-vector/pills-icons-set_2871175.htm#query=pills&position=1&from_view=search&track=sph)

Antidepressants have to change the neurotransmitter behaviour in the brain. Bulimia studies are still ongoing to try to understand the relationship between this drug and the change in the behaviour seen in bulimia.

Some researchers have noted that bulimia can be treated without CBT using antidepressants alone. But some others have noted that the patients do better with both forms of therapy.


It is also important to note that some patients with Bulimia have depression as a comorbidity and will benefit greatly from antidepressant therapy.

Among some of the explanations for why antidepressants work straightforwardly is the serotonin pathway that brings about satiety. But studies are still ongoing to see every part of this hypothesis.

They believe that lowered levels of serotonin are the reason behind binge and purge disorders in general and in bulimia too. Antidepressants that act to increase levels of serotonin help bring about this balance.



In one study where patients were given Prozac, the patients were noted to have reduced the number of episodes of binging and purging from over 22 cases to about 4 in a month. The control population were given a placebo in the study.

Even though the exact mechanism is still blurry, the result is very evident.



Fluoxetine has been the most helpful medication used in the treatment of bulimia. Some psychiatrists may choose other Selective Serotonin Reuptake inhibitors such as Celexa, Lexapro or Zoloft.

Serotonin-norepinephrine Reuptake Inhibitors work by increasing the concentration of serotonin and norepinephrine in the nerve synapses. Some popular brands include Effexor, Cymbalta and Yenetreve.





Monoamine oxidase stops the enzymes that break down the neurotransmitters in the body and they end up improving the depressed state of the individual. Popular brands of this drug class are Norpramin, Tofranil and Vivactil.




For now, Prozac is the only antidepressant that has been allowed by the food and drug administration for the treatment of BN. This is because of its ability to reduce the incidence of binging and purging seen in patients with BN.





The side effects seen in patients who need these drugs are just as documented as the use of the drugs. These should be reported to the physician once they are noted. Hey may cause nausea which seems very counterintuitive for a patient who typically would elicit their vomiting, there is also dizziness and tiredness. The patient may experience dryness in the mouth over time and hardening of stool with constipation. Some patients may lose their libido and will not have an interest in sexual activities.


It is important to make this emphasis to your patient as you start the treatment so they do not hide the fact that they feel likely to stop the medication.


The effects of this drug are usually noted about one to two weeks after commencement for most patients. These are important details to be emphasized to the patent when the therapy commences.



Some patients will need a dose adjustment and may not respond to Prozac and may need to be placed on trial for other brands of antidepressants.

Some studies show that CBT can be very helpful for patients that have BN and when the two are done together there are better results than when either is done. The patent should be encouraged to follow up with both.

The treatment for BN will have to include different healthcare workers and achieving good results will be a result of biological psychological and social modifications.

Antidepressants are very life-altering drugs and the patient should be encouraged to seek medical advice before making any decisions on taking them.



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![Vibes dimacations.png](https://files.peakd.com/file/peakd-hive/ebingo/23vsqueDeqMiXPMUbFQM6ReJsiU63MBTLZGStCb3FobcSrsf3qrdMZecHReN7Kv6GVC5L.png)
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# <center>Treatment</center>
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The CBT has done in BN id focused mainly on the clinical features seen in patients who have bulimia. These are the binging, the purging or compensatory mechanisms, and the need to be of a specific weight class.

To treat this condition the cycle of thought needs to be interrupted. The session usually lasts for up to 20 weeks and comprises 3 parts. He first is to interrupt the pattern of eating seen in these patients and to develop healthy habits eating. The habits to wards weight are also dealt with.


The second phase is more focused on the weight concerns of the patient and tries to clear up any other binge and purge episodes that might be outstanding.

In the third phase, the patient is to maintain the habits formed in the first toe phases to prevent relapses.

The thought patterns that lead to the binge and purge cycle are to be identified and done away with in the patient. Group therapy is not typically done but in some cases, it has been shown t be effective. The patient is usually dealt with individually.

No other therapy method has been shown to have the same effects CBT has on the patient.

Oxford University is developing a new type of CBT that have better effects on ED.


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# <center>Questions</center>
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- What did you learn about Eating Diorders?


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# <center>Conclusion</center>
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- The diagnostic criteria for BN are necessary for commencing treatment in people with BN.
- Prozac has been shown to have good results in those who have binge-purge disorders, especially BN.
- CBT is the best form of therapy for patients with BN.


![Medic Vibes Logo.png](https://files.peakd.com/file/peakd-hive/ebingo/AJhdrsjLeDph84bWdX9cMCvySBVnFziVCkTM3LkNaZ4Wza7QAVeRTn61CH1DKJq.png)
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# <center>References</center>
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- [Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry](https://www.amazon.com/Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry/dp/1451100477)
- Page demarcations made with [Inkscape.org](Inkscape.org)
- [Spine-Health](https://www.spine-health.com/conditions/spine-anatomy/anatomy-coccyx-tailbone
)
- [Eating Disorder Hope](https://www.eatingdisorderhope.com/blog/illusion-control-development-eating-disorders)