Psychopharmacological considerations for comorbid anorexia nervosa and bipolar disorder

Abstract

Anorexia nervosa is a serious psychiatric disorder defined by restrictive eating behaviors resulting in an unhealthy low body weight. Patients who have comorbid anorexia nervosa and bipolar disorder have more severe eating disorder symptomology as well as worse long-term prognosis. This case report follows the pharmacologic management of a patient with comorbid anorexia nervosa and bipolar disorder, highlighting important treatment considerations for this population. The patient was treated with antidepressants and mood stabilizers without consideration of the eating disorder for several years. Two psychoactive medications associated with food restriction (selegiline) and weight loss (bupropion) were prescribed after the patient reported concerns about her weight despite a normal body mass index. The bioavailability of another medication, lurasidone, depends on food intake, and the patient started feeling sedated when her restrictive eating remitted. This clinical phenomenon emphasizes the importance of careful psychopharmacological selection in more complex psychiatric patients. Effective treatment of comorbid anorexia nervosa and bipolar disorder requires continued assessment and treatment of disordered eating symptoms in conjunction with prudent psychopharmacological selection.