Bulimia Nervosa: When Psychotherapy Fails, Fluoxetine Is Worth a Try

When bulimic patients do not respond to psychological treatment or relapse afterward, a course of fluoxetine (Prozac) may be a useful intervention.

Dr. B. Timothy Walsh and associates at Columbia University tested the use of fluoxetine in 22 patients with bulimia nervosa who had not responded to, or who had relapses following, a course of cognitive behavioral therapy (CBT) or interpersonal psychotherapy (Am J Psychiatry 2000;8:1332). The patients were randomly assigned to receive a placebo (n=9) or fluoxetine (n=13), 60 mg/day, for 8 weeks.

Fluoxetine had a positive effect on binge eating and purging. The median frequency of binge eating within the previous 28 days declined from 22 to 4 episodes among the fluoxetine treatment group, but increased from 15 to 18 episodes among the group that received a placebo. In addition, purging in the previous 28 days declined from 30 to 6 episodes in the fluoxetine group but increased from 15 to 38 episodes in the placebo group.

In the future, longer-term studies will be helpful, due to the marked relapsing and remitting nature of bulimia nervosa. Also, it is useful to note that the 2 groups of patients were different before treatment was given.