Magazine article Clinical Psychiatry News

Fluoxetine Is TX of Choice for Bulimia, but Most Continue to Binge: Results with CBT Longer Lasting. (Treatment, Cognitive-Behavior Therapy)

Magazine article Clinical Psychiatry News

Fluoxetine Is TX of Choice for Bulimia, but Most Continue to Binge: Results with CBT Longer Lasting. (Treatment, Cognitive-Behavior Therapy)

Article excerpt

DENVER -- Fluoxetine at 60 mg/day is the clear pharmacologic therapy of first choice in bulimia nervosa, Dr. Katherine A. Halmi said at an international conference of the Academy for Eating Disorders.

Responders should remain on the drug for at least 6 months, according to Dr. Halmi, professor of psychiatry and director of the eating disorders program at Cornell University, N.Y.

Fluoxetine is the medication whose safety and efficacy for the treatment of bulimia nervosa are best established in clinical trials. That said, there is a problem with the use of fluoxetine, or indeed any other antidepressant, in treating this eating disorder. Regardless of whether selective serotonin reuptake inhibitors, tricyclic antidepressants, or MAO inhibitors are prescribed, complete abstinence from bingeing and purging occurs in only 20%-30% of treated patients. On average, a roughly 50% reduction in binge frequency occurs, she said.

Those short-term results pale beside those obtained with cognitive-behavioral therapy or interpersonal therapy. The benefits of antidepressant therapy aren't nearly as durable, either.

Dr. Halmi was a coinvestigator in a randomized single-blind trial involving year-long fluoxetine therapy or placebo in 150 bulimic patients with a favorable response to 8 weeks of fluoxetine. The study demonstrated that a slow breakthrough of symptoms occurs during long-term antidepressant therapy. Indeed, the frequency of bingeing and vomiting climbed by roughly three episodes per week over the course of a year in the fluoxetine arm and close to five episodes per week on placebo, although the final frequency of bingeing/purging in the fluoxetine group still remained significantly lower than at baseline (Am. J. Psychiatry 159[1]:96-102, 2002).

Poor compliance is another major problem with antidepressant therapy "By 5 months in the yearlong study, 50% of people had left--and it rapidly accelerated after that. So by the end of a year, only 17% of the original sample were left on fluoxetine. …

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