Article1991

Long-term outcome of antidepressant treatment for bulimia nervosa

B. Timothy Walsh · Colleen M. Hadigan · Michael J. Devlin · Madeline Gladis · Steven P. Roose

218 citations0/0 files storedAmerican Journal of Psychiatry

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Eating Disorders and Behaviors Nutrition, Health and Food Behavior Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Abstract

OBJECTIVE: The purpose of this study was 1) to replicate previous work indicating that antidepressant medication is superior to placebo in the treatment of bulimia nervosa and 2) to assess the long-term efficacy of this form of treatment. METHOD: Eighty patients entered a three-phase treatment protocol. An 8-week double-blind initiation phase was used to compare the effects of desipramine and placebo. Patients who responded satisfactorily to desipramine entered a 16-week maintenance phase. Patients who remained well were then randomly assigned to either desipramine or placebo for 6 additional months (discontinuation phase). The primary outcome measure was binge frequency, which was assessed weekly by self-report diaries. RESULTS: In the initiation phase the superiority of desipramine over placebo in reducing binge frequency was demonstrated. Patients treated with desipramine had a mean reduction in binge frequency of 47% at termination, whereas patients taking placebo experienced a mean increase of 7%. Less than half of the patients treated with desipramine met the criteria for entering the maintenance phase, and 29% of the patients entering that phase relapsed in the following 4 months. There were not enough patients in the discontinuation phase to permit clear conclusions about the need for continued antidepressant medication after 6 months of treatment. CONCLUSIONS: The study documents a beneficial effect of desipramine in the treatment of bulimia nervosa when compared to placebo. However, limited improvement and considerable relapse with continued treatment suggest serious limitations to the long-term efficacy of a single antidepressant trial in treating bulimia nervosa.

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References

1961An Inventory for Measuring Depression 1960A RATING SCALE FOR DEPRESSION 1965Society and the Adolescent Self-Image 1974The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory 1979The Eating Attitudes Test: an index of the symptoms of anorexia nervosa 1987The development and validation of the body shape questionnaire 1976Assessment of Social Adjustment by Patient Self-Report 1983Bulimia treated with imipramine: a placebo-controlled, double-blind study

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2009Psychological treatments for bulimia nervosa and binging 2001THE CONSEQUENCES AND COSTS OF THE EATING DISORDERS 2011World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Eating Disorders 1998Eating Disorders: Progress and Problems 2004Psychotherapy for bulimia nervosa and binging 1993Cognitive treatments for eating disorders.

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