The full content of Annals is available to subscribers

Subscribe/Learn More  >
Therapeutics |

Review: Psychological treatment is as effective as antidepressants for bulimia nervosa, but a combination is best

John F. Morgan, MD, MA
[+] Article, Author, and Disclosure 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):107. doi:10.7326/ACPJC-2002-136-3-107
Text Size: A A A

Questions: 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?

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 and book chapters on BN were also hand searched, and authors and pharmaceutical companies were contacted.

Study selection: 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.

Data extraction: 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).

Main results: 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).

Conclusions: 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*

OutcomesComparisonsWeighted event ratesRBI (95% CI)NNT (CI)
RemissionPT vs AD41% vs 20%63% (−14 to 210)Not significant
AD + PT vs AD47% vs 23%79% (11 to 188)5 (3 to 21)
PT + AD vs PT50% vs 36%30% (1 to 68)8 (5 to 37)
Clinical improvementPT + AD vs PT46% vs 52%8% (−70 to 50)Not significant
DropoutsPT vs AD18% vs 41%54%% (9 to 76)5 (3 to 10)
AD + PT vs AD35% vs 41%16% (−45 to 51)Not significant
PT + AD vs PT26% vs 16%74% (14 to 167)10 (6 to 40)

*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.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.