Article

Efficacy of cognitive behavioral therapy and fluoxetine for the treatment of binge eating disorder: a randomized double-blind placebo-controlled comparison. Biol Psychiatry

Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Biological Psychiatry (Impact Factor: 10.25). 03/2005; 57(3):301-9. DOI: 10.1016/j.biopsych.2004.11.002
Source: PubMed

ABSTRACT Cognitive behavioral therapy (CBT) and certain medications have been shown to be effective for binge eating disorder (BED), but no controlled studies have compared psychological and pharmacological therapies. We conducted a randomized, placebo-controlled study to test the efficacy of CBT and fluoxetine alone and in combination for BED.
108 patients were randomized to one of four 16-week individual treatments: fluoxetine (60 mg/day), placebo, CBT plus fluoxetine (60 mg/day) or CBT plus placebo. Medications were provided in double-blind fashion.
Of the 108 patients, 86 (80%) completed treatments. Remission rates (zero binges for 28 days) for completers were: 29% (fluoxetine), 30% (placebo), 55% (CBT+fluoxetine), and 73% (CBT+placebo). Intent-to-treat (ITT) remission rates were: 22% (fluoxetine), 26% (placebo), 50% (CBT+fluoxetine), and 61% (CBT+placebo). Completer and ITT analyses on remission and dimensional measures of binge eating, cognitive features, and psychological distress produced consistent findings. Fluoxetine was not superior to placebo, CBT+fluoxetine and CBT+placebo did not differ, and both CBT conditions were superior to fluoxetine and to placebo. Weight loss was modest, did not differ across treatments, but was associated with binge eating remission.
CBT, but not fluoxetine, demonstrated efficacy for the behavioral and psychological features of BED, but not obesity.

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    • "BED is linked with heightened medical and psychosocial problems [1] [2] and greater health-care utilization [3] relative to obese individuals without BED (NBO). Although certain psychological/behavioral [4] and pharmacological [5] treatments are effective for reducing binge-eating and associated psychopathology, most of these interventions generally result in minimal weight loss with obese BED patients [5] [6]. It has been suggested, however, that treatments that reduce binge eating may interrupt further weight gain [7]. "
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    • "Treatments for binge-eating behaviour A number of pharmacological treatments with differing mechanisms of action have been examined for binge eating in a number of disorders, particularly BED (Reas & Grilo, 2008). These include : the selective serotonin reuptake inhibitors (SSRIs), fluvoxamine (Hudson et al. 1998; Pearlstein et al. 2003), sertraline (McElroy et al. 2000), fluoxetine (Arnold et al. 2002; Devlin et al. 2005; Grilo et al. 2005), citalopram (McElroy et al. 2003a) and escitalopam (Guerdjikova et al. 2008); the noradrenaline reuptake inhibitor (NRI), atomoxetine (McElroy et al. 2007a) ; the anti-obesity agents, d-fenfluramine (a serotonin releaser and reuptake inhibitor) (Stunkard et al. 1996), sibutramine (a serotonin and noradrenaline reuptake inhibitor) (Appolinario et al. 2003; Milano et al. 2005; Mitchell et al. 2003; Wilfley et al. 2007) and orlistat (Golay et al. 2005) ; and the anticonvulsants, topiramate (McElroy et al. 2003b, 2007b) and sonisamide (McElroy et al. 2006). All of these drugs have been shown to exert positive effects (of moderate effect size) including reductions in binge-eating frequency and short-term reductions in weight (y3 kg) (Reas & Grilo, 2008), with larger effects on weight observed only with sibutramine , orlistat, topiramate and sonisamide. "
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