Stimulants for ADHD in context of eating disorder

[throwaway2222]

Let’s say you have a patient with uncontrolled anorexia and ADHD. Would stimulants such as adderall and Ritalin be unsafe? I believe they would be unsafe based on the cardiac risk in purge or binge-purge type of disorder. In restrictive type they would probably enable the restriction, but what other risks do I need to be considering? Obviously, they are indicated for binge eating disorder, but it’s other types of eating disorders that are more my concern.

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[hamstergang]

but what other risks do I need to be considering?

Why do you need to consider any more risks? Aren't those enough? Unless the patient were already on the stimulant medication, stable without issues developing from the medication before the development of the eating disorder, and cleared from a cardiac perspective, I wouldn't be giving them such a medication.

 

[calvnandhobbs68]

Also these patients don’t want to hear this but you know what’s the best thing for their attention and concentration? Appropriate nutrition. It’s kind of like people with active substance use disorders insisting their attention is so terrible. Well let’s get a good handle on the substance use disorder first. I’m not going to fight your poor cognition from other biological reasons with a stimulant.

I’d be hard pressed to give anyone with an active restricting/purging disorder stimulants of any kind. As you mentioned, stimulants can be appropriate in the context of binge eating disorder only.

 

[littlefred]

It’s kind of like people with active substance use disorders insisting their attention is so terrible. Well let’s get a good handle on the substance use disorder first. I’m not going to fight your poor cognition from other biological reasons with a stimulant.

Preach.

 

[aim-agm]

Isn't guanfacine associated with weight gain? Could be a good option.

 

[hamstergang]

Isn't guanfacine associated with weight gain? Could be a good option.

I don't typically expect any weight changes with guanfacine, but I'm sure if we looked it up something is possible. So buying for a moment that guanfacine is associated with weight gain, there are still some things we'd have to worry about.

To begin with, there be no reason to expect it to help with weight with Anorexia Nervosa as other medications that otherwise more reliably lead to weight gain don't help here either. And I would worry about the risk of hypotension in a patient is not eating or drinking enough and is likely bradycardic and hypotensive already.

For patients with Bulimia Nervosa, I would worry about medication causing weight gain leading to purging and then getting stuck in a binge/purge cycle.

Guanfacine is still an option -- there's no easy solution when eating disorders are involved.

 

[deleted1100659]

but if you just treated my ADHD, my eating disorder would probably improve too! same with my substance use disorder!

if someone is anorexic, just from a logical perspective alone, its really hard to justify giving them something that will suppress appetite.

People don't generally die from ADHD. People can die from severe eating disorders. You need to think of it in terms of "tiers". Tier 1 is the eating disorder, not the ADHD.