Fluoxetine Shows Promise For BED

A wide range of antidepressants, including the selective serotonin reuptake inhibitors (SSRIs) have been effective for people with bulimia nervosa (BN). Fluoxetine (Prozac®), the only drug currently approved for the treatment of eating disorders, has been effective for treating BN. Could it also be helpful for BED?

Lesley M. Arnold, MD and co-workers assessed the safety and effectiveness of fluoxetine among 60 outpatients with a DSM-IV diagnosis of BED. The participants were randomly assigned to receive either fluoxetine, 20-80 mg/day (30 patients), or placebo (30 patients) in a 6-week, double-blind, flexible-dose study (J Clin Psychiatry 2002; 63:1028). The dosage was begun at 20 mg, increased, as tolerated, to 40 mg/day for 3 days, and then increased to 60/mg/day. After 2 weeks, the dosage could be increased to 80 mg/day.

Results

The group treated with fluoxetine had a significantly greater reduction in frequency of binges, greater weight loss, and lower CG-S and HAM-D scores than did the placebo group. The mean dosage was 71 mg/day. At week 6, the estimated mean difference between groups in frequency of binges was 1.1.

Although fluoxetine was generally well tolerated, 24 people withdrew from the study—17 from the placebo group and 7 from the fluoxetine group. The most common reasons for this were: sedation, hand and foot swelling, palpitations, diarrhea, nausea and apathy. The most common effects reported by those treated with fluoxetine were dry mouth (11), headache (9), fatigue (6), and sedation (5).It is still not known how fluoxetine acts to treat BED. Although side effects such as anorexia, dyspepsia, and nausea may have helped reduce binge eating, in this study the incidence of these effects was not different in each group. Fluoxetine may act by correcting abnormal serotonin neurotransmission, according to the authors.