--Adolescent program parent
Medication may be part of successful treatment for bulimia nervosa. In multiple studies, treatment with antidepressants has been shown to be moderately effective in reducing the binge/purge cycle of an individual with bulimia nervosa. Trials have shown that antidepressants are superior to placebos in diminishing overeating, decreasing self-induced vomiting, and increasing the sense of control that someone has over their eating. Other studies show the response for those with bulimia to be similar to the rate of response with depression. Since it takes approximately two weeks to observe changes in depression with medication, it is implied that within two weeks some benefit may be seen in those with bulimia as well. Large scale evaluation of the studies of bulimia suggest that high doses of fluoxetine, generally within the range of 60 mg a day, has been optimum for reduction of behaviors and improvement of sense of control. In general, the rate of response to antidepressant medications, in particular fluoxetine, has been shown to be approximately 50%. To date, no consistent predictors of response have been identified. That is, a level of depression prior to treatment does not predict how well these will work with bulimia, even though they may be indicated for depression.
In no situation should medication be used alone for bulimia. Studies demonstrating the effectiveness of medication are clear that all medications are secondary to primary treatment with Cognitive Behavioral Therapy or Dialectical Behavioral Therapy. As noted above, fluoxetine, a selective serotonin re-uptake inhibitor "SSRI", has been studied more often than other medications. Studies by Walsh et al. suggest that taking an SSRI while undergoing Cognitive Behavioral Therapy can result in a significant reduction of symptoms of bulimia (Walsh, Wilson, Loeb, Devlin, Pike, Roose, Fleiss, & Waternaux, 1997). Studies also tend to show that by three weeks of treatment with an SSRI at an appropriate dosage, patients who will respond to medication have already started to show a response. Therefore, the benefits of SSRI treatment should be quickly experienced.
Of some concern with medication and bulimia is the potential seizure inducing risk of Wellbutrin. Because both bulimia and Wellbutrin have been associated with seizures, in general the use of Wellburtin in patients who have bulimia presents significant risk. It is not fully clear whether this risk is theoretical or has been experienced by a significant number of patients with bulimia, as studies of this question are not available. Given the theoretical risk, we try to avoid this combination whenever possible. There is also a small literature on the use of stimulants in patients with bulimia. These remain case reports and we await more thorough studies on this question. Again, given the potential seizure risk of stimulants, they should be used with caution.
A side note needs to be made concerning Topamax, which has been suggested by some clinicians as being an effective treatment for bulimia. To date, studies have not shown Topamax to be superior to an SSRI. Topamax may be associated with paresthesia (tingling) and cognitive impairment. Although Topamax has been reported to have effects on weight, the literature does not support using Topamx for weight issues with bulimia.
Walsh, B. T., Wilson, G. T., Loeb, K. L., Devlin, M. J., Pike, K. M., Roose, S. P., Fleiss, J., &
Waternaux, C. (1997). Medication and psychotherapy in the treatment of bulimia nervosa.
The American Journal of Psychiatry, 154:4, 523 - 531.
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Contributions by Sarah Emerman
Tags: Eating Disorder Treatment
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