Not everyone prefers to take medicine, and this is a fairly common complaint in doctors' offices, as well as in psychiatric offices, where drug treatment may be needed. The use of psychotropic medications, which act on the central nervous system, is still surrounded by many questions: How do antidepressants work? Will the soothing "black stripe" get me addicted forever? These questions are what make medications seem daunting. In this article, we will be focusing on eating disorders, more specifically, bulimia. The main international guidelines for the treatment of eating disorders recommend a combination of therapeutic resources such as psychotherapy, the use of medicines, nutritional monitoring, and clinical support, among other relevant strategies that help the clinical recovery process. Medication use is just one of the possible resources.

In more detail, bulimia is an eating disorder in which a person oscillates between overeating, with a feeling of loss of control of eating, and episodes of vomiting or laxative abuse trying to prevent weight gain. Also called bulimia nervosa, the disorder causes people to always be concerned about appearance, especially weight. The exact cause of bulimia is still unknown. It is an eating disorder and, therefore, many factors may be involved in the reasons for its occurrence. Among one of the more common factors that the everyday person thinks of is the influence of the media on people's behavior and standard of beauty, which may also be among the possible causes of bulimia. 

When prescribing a medicine to treat anorexia nervosa, bulimia nervosa, and binge eating disorder, for example, the focus is on helping the patient cope with the changes in thinking and creating eating behaviors that positively impact his/her life, as well as so-called comorbidities (diseases that also arise with the eating disorder). These include trying to prevent the dreadful fear of getting fat, incessant worry about eating, vomiting often to compensate for an episode of binge eating, feeling uncontrolled about eating, and being depressed, extremely anxious, or impulsive. These are situations that can be partially or totally improved with the use of a well-indicated medication. However, there is a particularity: in cases of anorexia nervosa, a classic characteristic of the patient is not to consider himself/herself ill, and for this reason, proposing the use of any medication may be understood as an unnecessary attitude or as a “threat” by the “risk of fatten". This is a challenge not only for the doctor, but for the entire multidisciplinary team that needs to help the patient and family in this refusal of treatment situation. 

It is worth mentioning that there may be a long road ahead. Building a relationship of trust with the psychiatrist is paramount for the patient to be able to ask questions, understand for what purpose the drug is being proposed and which side effects are most frequently manifested for a given drug. In this way, the safety of taking the medication will be greater and the path to full recovery will certainly be shorter and more successful. 

References: 

https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615 

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia