John F. Morgan, MD, MA
In patients with bulimia nervosa (BN), are antidepressants effective for increasing remission and clinical improvement?
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.
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.
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).
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).
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*
*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.
Morgan JF. Review: Antidepressants increase remission and clinical improvement in bulimia nervosa. Ann Intern Med. ;136:106. doi: 10.7326/ACPJC-2002-136-3-106
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Published: Ann Intern Med. 2002;136(3):106.
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