John F. Morgan, MD, MA
In patients with bulimia nervosa (BN), are antidepressants as effective as psychological treatment (PT) for increasing remission and clinical improvement rates? Is a combination of antidepressants and PT better than each intervention alone?
Studies were identified by searching MEDLINE; EMBASE/Excerpta Medica; LILACS; PsycLIT; SCISEARCH; the Cochrane Depression, Anxiety, and Neurosis Group Database of Trials; the Cochrane Controlled Trials Register; Clinical Evidence; and reference lists. The International Journal of Eating Disorders and book chapters on BN were also hand searched, and authors and pharmaceutical companies were contacted.
Studies were selected if they were randomized controlled trials (RCTs) that compared antidepressants with PT in patients with BN. Studies were excluded if patients had binge-eating or purging-type anorexia nervosa or binge-eating disorder.
2 reviewers assessed the quality of studies and extracted data on patients, study characteristics, interventions, and outcomes (including remission [100% reduction in binge or purge episodes], clinical improvement ≥ 50% reduction in binge or purge episodes], and dropouts).
5 RCTs (237 patients) compared antidepressants with PT. Groups did not differ significantly for remission (5 RCTs); only 1 RCT reported on clinical improvement. More dropouts occurred in the antidepressant group than in the PT group (4 RCTs) (Table). 5 RCTs (247 patients) compared combination and single interventions.
Antidepressants vs combination: More patients in the combination group than in the antidepressant-alone group had remission (4 RCTs) (Table); only 1 RCT reported on clinical improvement. Groups did not differ for dropout rates (4 RCTs).
PT vs combination: More patients in the combination group than in the PT-alone group had remission (6 RCTs); fewer patients in the PT-alone group than in the combination group dropped out (6 RCTs) (Table). Groups did not differ for clinical improvement (2 RCTs) (Table).
In patients with bulimia nervosa, psychological treatment (PT) and antidepressants do not differ in remission rates, but dropout rates are lower with PT. A combination of antidepressants and PT is best for increasing remission.
Antidepressants (AD) vs psychological treatment (PT) for bulimia nervosa*
*RBR = relative benefit reduction. Other abbreviations defined in Glossary; RBI, RBR, RRR, RRI, NNT, NNH, and CI calculated from data in article. Follow-up ranged from 5 to 24 weeks.
Morgan JF. Review: Psychological treatment is as effective as antidepressants for bulimia nervosa, but a combination is best. Ann Intern Med. ;136:107. doi: 10.7326/ACPJC-2002-136-3-107
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Published: Ann Intern Med. 2002;136(3):107.
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