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: 13.56). 05/1997; 154(4):523-31.
Source: PubMed

ABSTRACT 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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Available from: Kathleen M Pike, Aug 19, 2015
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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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    • "Despite the overlap between EDs and depression, FDA-approved antidepressants have not shown promise in alleviating depression in patients with EDs. Although fluoxetine has been approved to treat bulimia nervosa (BN), the drug has shown mixed efficacy in reducing MDD in this group (Pope et al. 1983; Fichter et al. 1991; Fluoxetine Bulimia Nervosa Collaborative Study Group, 1992; Goldbloom & Olmsted, 1993; Beumont et al. 1997; Walsh et al. 1997; Romano et al. 2002). Moreover, antidepressant treatment does not result in improvement in depressive symptomatology in anorexia nervosa (AN) treatment trials (Attia et al. 1998; Walsh et al. 2006). "
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    ABSTRACT: We examined the course of major depressive disorder (MDD) and predictors of MDD recovery and relapse in a longitudinal sample of women with eating disorders (ED). 246 Boston-area women with DSM-IV anorexia nervosa-restricting (ANR; n=51), AN-binge/purge (ANBP; n=85), and bulimia nervosa (BN; n=110) were recruited between 1987 and 1991 and interviewed using the Eating Disorders Longitudinal Interval Follow-up Evaluation (LIFE-EAT-II) every 6-12 months for up to 12 years. 100 participants had MDD at study intake and 45 developed MDD during the study. Psychological functioning and treatment were assessed. Times to MDD onset (1 week-4.3 years), recovery (8 weeks-8.7 years), and relapse (1 week-5.2 years) varied. 70% recovered from MDD, but 65% subsequently relapsed. ANR patients were significantly less likely to recover from MDD than ANBP patients (p=0.029). Better psychological functioning and history of MDD were associated with higher chance of MDD recovery. Higher baseline depressive severity and full recovery from ED were associated with greater likelihood of MDD relapse; increased weight loss was somewhat protective. Adequate antidepressant treatment was given to 72% of patients with MDD and generally continued after MDD recovery. Time on antidepressants did not predict MDD recovery (p=0.27) or relapse (p=0.26). Small ED diagnostic subgroups; lack of non-ED control group. The course of MDD in EDs is protracted; MDD recovery may depend on ED type. Antidepressants did not impact likelihood of MDD recovery, nor protect against relapse, which may impact on treatment strategies for comorbid MDD and EDs.
    Journal of Affective Disorders 11/2010; 130(3):470-7. DOI:10.1016/j.jad.2010.10.043 · 3.71 Impact Factor
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    • "The primary ROC analyses used the entire patient sample, pooled across treatment arms, to predict nonresponse defined as the failure to achieve at least a 75 % reduction in symptoms at weeks 7 and 8. Nonresponse was chosen as the primary outcome because patients who fail to respond and require a change in treatment are the more clinically important group to identify. The criterion of a 75 % reduction in symptoms has been used as an outcome in other medications studies of BN (Pope et al. 1983 ; Walsh et al. 1987 ; Fluoxetine Bulimia Nervosa Collaborative Study Group, 1992 ; Goldstein et al. 1995) and allowed for comparisons with our earlier study of early response to desipramine (Walsh et al. 2006). Furthermore, although abstinence is an important goal for a full course of treatment for BN, a 75 % reduction is a clinically significant change in the first 7 or 8 weeks of treatment. "
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    ABSTRACT: Bulimia nervosa (BN) is a serious psychiatric disorder characterized by frequent episodes of binge eating and inappropriate compensatory behavior. Numerous trials have found that antidepressant medications are efficacious for the treatment of BN. Early response to antidepressant treatment, in the first few weeks after medication is initiated, may provide clinically useful information about an individual's likelihood of ultimately benefitting or not responding to such treatment. The purpose of this study was to examine the relationship between initial and later response to fluoxetine, the only antidepressant medication approved by the US Food and Drug Administration (FDA) for the treatment of BN, with the goal of developing guidelines to aid clinicians in deciding when to alter the course of treatment. Data from the two largest medication trials conducted in BN (n=785) were used. Receiver operating characteristic (ROC) curves were constructed to assess whether symptom change during the first several weeks of treatment was associated with eventual non-response to fluoxetine at the end of the trial. Eventual non-responders to fluoxetine could be reliably identified by the third week of treatment. Patients with BN who fail to report a 60% decrease in the frequency of binge eating or vomiting at week 3 are unlikely to respond to fluoxetine. As no reliable relationships between pretreatment characteristics and eventual response to pharmacotherapy have been identified for BN, early response is one of the only available indicators to guide clinical management.
    Psychological Medicine 06/2010; 40(6):999-1005. DOI:10.1017/S0033291709991218 · 5.43 Impact Factor
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