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Review: Antidepressants increase remission and clinical improvement in bulimia nervosa

John F. Morgan, MD, MA
[+] Article and Author Information

Source of funding: Not stated.

For correspondence: Dr. J. Bacaltchuk, Universidade Federal de São Paulo, São Paulo—SP, Brazil. E-mail bacaltc@ibm.net.


Ann Intern Med. 2002;136(3):106. doi:10.7326/ACPJC-2002-136-3-106
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Question: In patients with bulimia nervosa (BN), are antidepressants effective for increasing remission and clinical improvement?

Data sources: 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 was also hand searched, and authors and pharmaceutical companies were contacted.

Study selection: Studies were selected if they were randomized controlled trials (RCTs) that compared any antidepressant with placebo for ≥ 4 weeks in patients with BN. RCTs were excluded if patients had binge-eating or purging-type anorexia nervosa or binge-eating disorder.

Data extraction: 2 reviewers assessed the quality of RCTs and extracted data on patients, study characteristics, drug regimens, and outcomes (including remission [100% reduction in binge or purge episodes], clinical improvement ≥ 50% reduction in binge or purge episodes], and dropouts).

Main results: 16 RCTs (1300 patients) met the selection criteria. Any antidepressant was better than placebo for increasing remission at a mean follow-up of 8 weeks (8 RCTs) and clinical improvement at a mean follow-up of 9 weeks (8 RCTs) (Table). Groups did not differ for dropout rates (14 RCTs) (Table).

Conclusion: In patients with bulimia nervosa, antidepressants are effective in the short term for increasing remission and clinical improvement rates.

Antidepressants vs placebo for bulimia nervosa at 6 to 16 weeks*

OutcomesAntidepressant typeWeighted event ratesRBI (95% CI)NNT (CI)
RemissionAll types20% vs 7.9%105% (32 to 219)9 (6 to 16)
TCAs14% vs 9.1%136% (−4 to 476)Not significant
MAOIs25% vs 6.3%229% (−22 to 1289)Not significant
Other antidepressants15% vs 0%664% (−1 to 5773)7 (4 to 27)
Clinical improvementAll types64% vs 33%84% (38 to 145)4 (3 to 5)
TCAs77% vs 17%294% (59 to 872)2 (2 to 3)
SSRIs58% vs 38%51% (26 to 81)5 (4 to 9)
Other antidepressants44% vs 8.2%321% (74 to 919)3 (3 to 5)
RRR (CI)NNT
DropoutsSSRIs34% vs 40%18% (1 to 32)Not significant
Other antidepressants30% vs 32%6% (−83 to 52)Not significant
RRI (CI)NNH
All types34% vs 31%3% (−20 to 32)Not significant
TCAs26% vs 11%93% (15 to 225)Not significant
MAOIs34% vs 29%20% (−33 to 113)Not significant

*MAOIs = monoamine oxidase inhibitors; SSRIs = selective serotonin reuptake inhibitors; TCAs = tricyclic antidepressants. Other abbreviations defined in Glossary; RBI, RRR, RRI, NNT, NNH, and CI calculated from data in article.

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