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Medication in bulimia nervosa

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Seek specialist advice:

  • do not offer medication as the sole treatment for bulimia nervosa (1)

  • drug treatment is believed to be inferior to that of psychotherapy (cognitive behaviour therapy), which produces more substantial and long-lasting change (2). In patients with bulimia nervosa, psychological treatment and antidepressants do not differ in remission rates, but dropout rates are lower with psychological treatment. A combination of antidepressants and psychological treatment is the best for increasing remission (3)

  • antidepressant drugs, including SSRIs, monoamine oxidase inhibitors and tricyclics, have been shown to be more effective than placebo in the short-term treatment of bulimia. A study using fluoxetine at doses (60 mg daily) above those generally used in the treatment of depression resulted in a reduction of bulimic and depressive symptoms in patients with bulimia nervosa
    • more detailed examination of the available evidence has been undertaken (4)
      • SSRIs
        • a systematic review found that fluoxetine 60 mg daily increased the number of people with clinical improvement but not remission compared with placebo
      • monoamine oxidase inhibitors
        • systematic review, found that monoamine oxidase inhibitors improved remission rates compared with placebo, but found no significant difference in improvement in bulimic symptoms or depression scores
      • TCAs
        • one systematic review found that tricyclic antidepressants (desipramine and imipramine) improved bulimic symptoms and reduced binge eating compared with placebo

Reference:

  1. NICE (May 2017). Eating disorders: recognition and treatment
  2. Prescribers Journal 1999; 39 (4):227-33.
  3. Baccaltchuk J et al (2001). Antidepressants versus psychological treatments and their combination for bulimia nervosa. Cochrane Database Syst Rev, CD003385 (latest version 13 Aug 2001
  4. Clinical Evidence (January 2006).Bulimia Nervosa

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