Medication in bulimia nervosa

Seek specialist advice:

• do not offer medication as the sole treatment for bulimia nervosa (1)
  
  
• drug treatment is believed to be inferior to that of psychotherapy (cognitive behaviour therapy), which produces more substantial and long-lasting change (2). In patients with bulimia nervosa, psychological treatment and antidepressants do not differ in remission rates, but dropout rates are lower with psychological treatment. A combination of antidepressants and psychological treatment is the best for increasing remission (3)
  
  
• antidepressant drugs, including SSRIs, monoamine oxidase inhibitors and tricyclics, have been shown to be more effective than placebo in the short-term treatment of bulimia. A study using fluoxetine at doses (60 mg daily) above those generally used in the treatment of depression resulted in a reduction of bulimic and depressive symptoms in patients with bulimia nervosa
  • more detailed examination of the available evidence has been undertaken (4)
    • SSRIs
      • a systematic review found that fluoxetine 60 mg daily increased the number of people with clinical improvement but not remission compared with placebo
    • monoamine oxidase inhibitors
      • systematic review, found that monoamine oxidase inhibitors improved remission rates compared with placebo, but found no significant difference in improvement in bulimic symptoms or depression scores
    • TCAs
      • one systematic review found that tricyclic antidepressants (desipramine and imipramine) improved bulimic symptoms and reduced binge eating compared with placebo

Reference:

1. NICE (May 2017). Eating disorders: recognition and treatment
2. Prescribers Journal 1999; 39 (4):227-33.
3. Baccaltchuk J et al (2001). Antidepressants versus psychological treatments and their combination for bulimia nervosa. Cochrane Database Syst Rev, CD003385 (latest version 13 Aug 2001
4. Clinical Evidence (January 2006).Bulimia Nervosa