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*
| Outcomes | Antidepressant type | Weighted event rates | RBI (95% CI) | NNT (CI) |
| Remission | All types | 20% vs 7.9% | 105% (32 to 219) | 9 (6 to 16) |
| TCAs | 14% vs 9.1% | 136% (−4 to 476) | Not significant |
| MAOIs | 25% vs 6.3% | 229% (−22 to 1289) | Not significant |
| Other antidepressants | 15% vs 0% | 664% (−1 to 5773) | 7 (4 to 27) |
| Clinical improvement | All types | 64% vs 33% | 84% (38 to 145) | 4 (3 to 5) |
| TCAs | 77% vs 17% | 294% (59 to 872) | 2 (2 to 3) |
| SSRIs | 58% vs 38% | 51% (26 to 81) | 5 (4 to 9) |
| Other antidepressants | 44% vs 8.2% | 321% (74 to 919) | 3 (3 to 5) |
| | | RRR (CI) | NNT |
| Dropouts | SSRIs | 34% vs 40% | 18% (1 to 32) | Not significant |
| Other antidepressants | 30% vs 32% | 6% (−83 to 52) | Not significant |
| | | RRI (CI) | NNH |
| All types | 34% vs 31% | 3% (−20 to 32) | Not significant |
| TCAs | 26% vs 11% | 93% (15 to 225) | Not significant |
| MAOIs | 34% vs 29% | 20% (−33 to 113) | Not significant |