Antidepressants versus placebo for the treatment of bulimia nervosa: a systematic review*

Abstract

The use of a single antidepressant agent was clinically effective for the treatment of bulimia nervosa when compared with placebo, with an overall greater remission rate and a higher rate of drop-outs. No differential effect regarding efficacy and tolerability among the various classes of antidepressants could be demonstrated.

Efficacy of sertraline for bulimia nervosa

“…The first limitation was the uncontrolled open trial design. As eating disorder patients have been shown to respond to placebo treatment (Bacaltchuk et al, 1999), we cannot exclude the possibility that the positive response to treatment was specifically in response to the sertraline treatment. Therefore, it will be important to examine the efficacy of sertraline in a double-blind, placebo-controlled trial that includes a larger sample size than that examined in the current study.…”

“…A number of efficacious psychological interventions exist for bulimia nervosa (BN), including cognitive, behavioral, and family therapy (Wilson & Fairburn, 2002). Psychotropic medications are also frequently used to treat BN patients and studies have shown that several classes of medications are efficacious (Agras, 2001;Bacaltchuk, Hay, & Mari, 1999;Freeman, 1998). One of the most common classes of medications used with BN patients is the selective serotonin reuptake inhibitors (SSRIs; Agras, 2001), with fluoxetine receiving the most attention from investigators thus far.…”

Extracts from "Clinical Evidence": Bulimia nervosa

“…The second systematic review found significantly higher withdrawal rates in people taking antidepressants than with placebo (12 RCTs, 10.5% v 5.1%) 29. It found no significant difference in withdrawal rates due to adverse effects among and within classes of antidepressants.…”

“…We found two systematic reviews, 21 29 two additional RCTs, 30 31 and two subsequent RCTs. 32 33 Versus placebo: Both reviews found that antidepressants reduced bulimic symptoms.…”

“…The review found no significant difference in effect between different classes of antidepressants, but there were too few trials to exclude a clinically important difference (table 2). Fluoxetine was the only selective serotonin reuptake inhibitor included in the review, and only one trial reported remission rates 29. Two additional RCTs (not in either of the above reviews) found that significantly more improvement was maintained after withdrawal of antidepressant treatment that had been continued for six months 34.…”