Medication and psychotherapy in the treatment of bulimia nervosa

Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 05/1997; 154(4):523-31. DOI: 10.1176/ajp.154.4.523
Source: PubMed


Two treatments for bulimia nervosa have emerged as having established efficacy: cognitive-behavioral therapy and antidepressant medication. This study sought to address 1) how the efficacy of a psychodynamically oriented supportive psychotherapy compared to that of cognitive-behavioral therapy; 2) whether a two-stage medication intervention, in which a second antidepressant (fluoxetine) was employed if the first (desipramine) was either ineffective or poorly tolerated, added to the benefit of psychological treatment; and 3) if the combination of medication and psychological treatment was superior to a course of medication alone.
A total of 120 women with bulimia nervosa participated in a randomized, placebo-controlled trial.
Cognitive-behavioral therapy was superior to supportive psychotherapy in reducing behavioral symptoms of bulimia nervosa (binge eating and vomiting). Patients receiving medication in combination with psychological treatment experienced greater improvement in binge eating and depression than did patients receiving placebo and psychological treatment. In addition, cognitive-behavioral therapy plus medication was superior to medication alone, but supportive psychotherapy plus medication was not.
At present, cognitive-behavioral therapy is the psychological treatment of choice for bulimia nervosa. A two-stage medication intervention using fluoxetine adds modestly to the benefit of psychological treatment.

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    • "Several studies that have assessed the combined effectiveness of antidepressant medication and CBT found that the combination was superior to either one used separately (Walsh et al., 1997). In a meta-analysis of BN treatment outcomes, nine medication trials (870 participants) and twenty-six randomized psychosocial studies (460 participants) were included (Whittal, 1999). "
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    ABSTRACT: Enhanced cognitive behaviour therapy (CBT-E) is the first-line treatment for bulimia nervosa (BN) in adulthood. There is limited evidence for therapies for children and adolescents with BN; however family-based treatment (FBT) is being increasingly used. This case study contrasts the delivery of FBT with an augmented version (CBT-E) in two adolescents presenting with BN. In both cases, the adolescents achieved remission from BN symptoms, (cessation of bingeing and compensatory behaviour) at the end of treatment. The families reported that FBT provided a platform for them to work together and view BN as a family issue, rather than leaving the onus on the young person to recover independently. The addition of CBT-E strategies assisted with managing cognitions associated with bodyweight and shape concerns and appeared to be useful in a more complex presentation with comorbidities. Future research should examine the effectiveness of augmenting CBT-E strategies to FBT using larger samples and more rigorous research designs.Practitioner pointsInvolving families in the treatment of adolescent BN is both effective and acceptable to young people and their families.Two promising treatment approaches, FBT-BN and CBT-E, can effectively be combined to provide a therapy which has the strengths of both modalities alone.Adolescents with comorbidities or complex presentations may benefit most from combining the two modalities to develop additional skills and strategies.
    Journal of Family Therapy 09/2015; DOI:10.1111/1467-6427.12095 · 1.02 Impact Factor
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    • "Overall, no differences have emerged between combined treatments and CBT alone for reducing binge/purge frequency.69–72 However, there has been some evidence that the addition of antidepressant medication may improve depressive symptoms above CBT alone.72,73 Walsh and colleagues72 compared 16 weeks of CBT guided self-help with placebo, CBT guided self-help with fluoxetine, fluoxetine alone, and placebo alone in 91 patients. "
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    ABSTRACT: Eating disorders are a significant source of psychiatric morbidity in young women and demonstrate high comorbidity with mood, anxiety, and substance use disorders. Thus, clinicians may encounter eating disorders in the context of treating other conditions. This review summarizes the efficacy of current and emerging treatments for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Treatment trials were identified using electronic and manual searches and by reviewing abstracts from conference proceedings. Family based therapy has demonstrated superiority for adolescents with AN but no treatment has established superiority for adults. For BN, both 60 mg fluoxetine and cognitive behavioral therapy (CBT) have well-established efficacy. For BED, selective serotonin reuptake inhibitors, CBT, and interpersonal psychotherapy have demonstrated efficacy. Emerging directions for AN include investigation of the antipsychotic olanzapine and several novel psychosocial treatments. Future directions for BN and BED include increasing CBT disseminability, targeting affect regulation, and individualized stepped-care approaches.
    Substance Abuse: Research and Treatment 03/2012; 6(1):33-61. DOI:10.4137/SART.S7864
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    • "Tuttavia, la CTB sembra più efficace nel ridurre la frequenza del vomito e la sintomatologia depressiva associata. Walsh e collaboratori (1997) hanno paragonato una psicoterapia di sostegno a orientamento analitico alla CBT e a una terapia farmacologica con antidepressivi in un campione di 120 pazienti bulimiche assegnate in modo casuale a cinque gruppi. I risultati suggeriscono che la CBT è superiore alla psicoterapia psicodinamica nel ridurre i sintomi bulimici e che, se combinata alla farmacoterapia, produce un miglioramento superiore alla sola farmacoterapia; per contro, la terapia di sostegno sembra offrire poco beneficio addizionale alla farmacoterapia configurandosi quindi come un trattamento poco efficace per la bulimia. "
    Psicoanalisi in trincea, 01/2012: pages 263-3055; Franco Angeli.
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