Mental health
Medicines for Bulimia nervosa
A serious eating disorder with recurrent episodes of binge eating followed by behaviours meant to "undo" them — such as making yourself sick, taking laxatives, fasting or over-exercising — alongside an over-focus on weight and shape; the first-line treatment is psychological therapy, with an SSRI sometimes added, and getting help early matters.
Education and reference only. This explains which medicines are used and why, in plain language — it deliberately contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician, and check the BNF and the product labelling for prescribing detail.
Quick answer
What is Bulimia nervosa?
Bulimia nervosa is an eating disorder in which a person has recurrent episodes of binge eating — eating a large amount of food in a short time with a feeling of being out of control — followed by compensatory behaviours intended to prevent weight gain, such as making themselves sick (vomiting), misusing laxatives or other medicines, fasting, or exercising excessively. Running through it is an intense preoccupation with weight and body shape, and how a person feels about themselves becomes heavily tied to these.
- How it is treated: The cornerstone of treatment is psychological therapy, and most people can be helped in the community.
- Self-care: Recovery is supported by working towards a regular pattern of eating rather than restricting and then bingeing, being open with the people supporting you, leaning on family, friends or a charity such as Beat rather than coping alone, and addressing low mood and anxiety.
- When to seek help: Speak to your GP if you are caught in a cycle of binge eating and trying to undo it by being sick, using laxatives, fasting or over-exercising, or if worries about weight and shape are dominating your life — eating disorders are serious but treatable, and getting help early gives the best chance of recovery.
What it is
Bulimia nervosa is an eating disorder in which a person has recurrent episodes of binge eating — eating a large amount of food in a short time with a feeling of being out of control — followed by compensatory behaviours intended to prevent weight gain, such as making themselves sick (vomiting), misusing laxatives or other medicines, fasting, or exercising excessively. Running through it is an intense preoccupation with weight and body shape, and how a person feels about themselves becomes heavily tied to these. The cycle of bingeing and purging is often kept secret and is accompanied by guilt, shame and distress, and people may be of normal weight, so it is not always obvious from the outside. Bulimia is a serious mental illness, not a lifestyle choice, a phase or a matter of vanity or willpower, and it can affect anyone regardless of age, gender or background. It commonly occurs alongside low mood, anxiety and other difficulties. It is treatable, and the sooner someone gets help the better the outlook.
How it is treated
The cornerstone of treatment is psychological therapy, and most people can be helped in the community. A typical first step is a guided self-help programme focused on bulimia, in which a person works through a structured programme with support from a clinician. If that is not enough or is not suitable, the next step is eating-disorder-focused cognitive behavioural therapy (sometimes written CBT-ED), a talking therapy designed specifically for eating disorders that addresses both the eating behaviours and the thoughts and feelings about weight and shape that keep the cycle going. Medication is not the main treatment but can have a place: an SSRI antidepressant (fluoxetine is the one most often used) may be added to help reduce the frequency of binge eating and purging, particularly alongside psychological therapy. Care is usually shared between the GP, eating-disorder services and the person, with regular review. Because repeated vomiting and laxative misuse can affect physical health, monitoring the body — including the heart and the body's salts — is an important part of the plan. Treatment also gives space to address linked problems such as depression and anxiety.
For this condition, these medicines
Medicine classes used for Bulimia nervosa
Each links to a full, dose-free guide — what it is, how it works, who can and cannot use it, side effects, interactions and FAQs.
Symptom checker
Symptoms that can point to Bulimia nervosa
Bulimia nervosa can be one cause of these symptoms. Each guide explains the other possible causes and the red-flag warning signs that mean you should get urgent help:
Beyond medication
Lifestyle and self-care
Recovery is supported by working towards a regular pattern of eating rather than restricting and then bingeing, being open with the people supporting you, leaning on family, friends or a charity such as Beat rather than coping alone, and addressing low mood and anxiety. It is best to make changes with professional guidance, and trusted support — including Beat's helplines — can help you take the first step and stay with treatment.
When to get help
When to see a doctor
Speak to your GP if you are caught in a cycle of binge eating and trying to undo it by being sick, using laxatives, fasting or over-exercising, or if worries about weight and shape are dominating your life — eating disorders are serious but treatable, and getting help early gives the best chance of recovery. There are also particular physical dangers to be aware of: repeated vomiting and laxative misuse can disturb the balance of salts (electrolytes) in the body and lead to dangerous heart-rhythm problems, as well as harm to the teeth and other parts of the body, so it is important to involve a doctor. Seek urgent help if you feel faint, have palpitations, an irregular heartbeat, chest pain, severe weakness or fits. As with any mental illness, get help straight away if you have thoughts of harming yourself: call 999 or go to A&E if anyone is in immediate danger, call 111 for urgent advice, and the Samaritans are there day or night on 116 123. The eating-disorders charity Beat also runs helplines that can support you and those around you.
Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.
Answers
Bulimia nervosa: frequently asked questions
What medicines are used for bulimia nervosa?
Medication is not the main treatment for bulimia — psychological therapy comes first, starting with a guided self-help programme and, if needed, eating-disorder-focused cognitive behavioural therapy. Where medicine is used, an SSRI antidepressant is the usual choice, and fluoxetine is the one most often used. It is generally added alongside talking therapy to help reduce how often binge eating and purging happen, rather than used on its own. Whether an SSRI is right for you, and how it fits with therapy, is decided with your doctor, who will also review it over time.
Is bulimia a serious illness or just about willpower?
Bulimia nervosa is a serious mental illness, not a lifestyle choice, a phase or a failure of willpower. It has real effects on both mental and physical health, and the repeated cycle of bingeing and purging can cause genuine harm, including to the heart. It can affect anyone, whatever their age, gender, background or body weight, and people often hide it because of shame. None of this is a person's fault. The important message is that it is treatable and that asking for help — from a GP, eating-disorder service or a charity such as Beat — is a sign of strength, not weakness.
Why is bulimia dangerous for the heart and body?
Making yourself sick repeatedly and misusing laxatives can upset the balance of salts (electrolytes) such as potassium in the body. These salts help the heart beat normally, so when they fall too low or become unbalanced it can cause dangerous heart-rhythm problems, which is one reason bulimia can be life-threatening. Repeated vomiting can also damage the teeth, throat and gullet, and cause other physical harm. This is why a doctor should be involved, monitoring your physical health as part of treatment, and why symptoms like palpitations, fainting or severe weakness need urgent medical attention.
What treatment works best for bulimia?
The most effective treatments are psychological therapies. For many people the first step is a guided self-help programme focused on bulimia, working through a structured programme with support from a clinician. If that is not enough or not suitable, eating-disorder-focused cognitive behavioural therapy (CBT-ED) is recommended — a talking therapy designed for eating disorders that tackles both the eating behaviours and the thoughts about weight and shape that keep the cycle going. An SSRI may be added to help reduce bingeing and purging. Care is shared with your GP and eating-disorder services, with physical health monitored along the way.
Sources
Where this is drawn from
- NICE NG69.
- Beat (eating disorders charity).
Related conditions
Browse by body system
Building a patient-information or formulary resource?
We create evidence-led, dose-free clinical references and decision aids for teams.