Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
9.6 Major clinical issues with eating disorders and stimulant (including methamphetamine) use
Table of contents
- Acknowledgments
- Abbreviations
- Preface
- Introduction
- Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
1. Levels of evidence- 2. Management of people with comorbidity of mental disorders and substance use
- 3. The common drug groups
- 4. Tobacco
- 5. Depression and substance use
- 6. Anxiety disorders and substance use
- 7. Psychosis (schizophrenia and bipolar disorder) and substance use
- 8. Personality disorders and substance use
9. Eating disorders and substance use- 9.1 Eating disorders
- 9.2 Comorbidity with eating disorders
- 9.3 Major clinical issues with eating disorders and cannabis/ hallucinogen use
- 9.4 Major clinical issues with eating disorders and alcohol use
- 9.5 Major clinical issues with eating disorders and opioid use
- 9.6 Major clinical issues with eating disorders and stimulant (including methamphetamine) use
- 9.7 Major clinical issues with eating disorders and benzodiazepine use
- 9.8 Major clinical issues with eating disorders and inhalant/ solvent use
- 10. Somatoform disorders and substance use
- 11. Gambling and substance use
- 12. Brain injury, mental disorders and substance use
- 13. Bibliography
- 14. Appendices
- People with eating disorders may use stimulants to control appetite and to provide energy for exercise.
- MAO-Is (either irreversible or reversible) are contraindicated in people using amphetamines or MDMA. Deaths have been associated with concurrent use of moclobemide and MDMA.
- The use of stimulants at any level should be discouraged.
- CBT can be used to address stimulant use and the eating disorder.
- In particular, assistance with coping skills may assist with impulsive use of stimulants and bingeing behaviours.
9.6.1 Effects of stimulants on eating disorders
- People with eating disorders may use stimulants to control appetite and to provide energy for exercise(360). Consequently, dependence can develop.
- High rates of cocaine and amphetamine use have been observed in people with eating disorders(347).
- Appetite suppression and weight loss have been reported to be the reason for the commencement and continuation of cocaine(340).
- Severity of bulimia has been shown to correlate with the frequency of MDMA and amphetamine use, with users reporting that ecstasy aids in weight loss(360).
9.6.2 Interactions between stimulants and therapeutic agents for eating disorders
- Stimulant drugs are likely to exacerbate the effects of SSRI and SNRI antidepressants in particular (and vice versa) and may result in serotonin syndrome (Appendix 1)x(127, 179, 180). Patients should be warned of signs of serotonin syndrome and be monitored.
- MAO-Is (either irreversible or reversible) are contraindicated in people using amphetamines or MDMA. Deaths have been associated with concurrent use of moclobemide and MDMAxxx(181, 182).
- Fluoxetine, paroxetine and norfluoxetine can inhibit the metabolism of MDMA through inhibition of the CYPs involved in its metabolism and may therefore cause toxicityx.
9.6.3 Management approaches to comorbid eating disorders and stimulant use
- The use of stimulants at any level should be discouraged due to the risk of dependence and, most importantly, the possibility of increased chances of toxicity.
- CBT can be used to address stimulant use***(49, 183) and the eating disorder****(343, 344). In particular, assistance with coping skills may assist with impulsive use of stimulants and bingeing behaviours.
