Bulimia nervosa antidepressants

Fluoxetine (Prozac). The first SSRI introduced in the United States, fluoxetine was for many years the most prescribed antidepressant in the world. It is approved for the treatment of MDD, OCD, and bulimia nervosa. Fluoxetine can be started at 10 or 20 mg in a single dose taken with a meal. Many patients experience a complete recovery at the 20mg/day dose, but fluoxetine can be increased up to 80mg/day. The treatment of bulimia nervosa and OCD usually requires these higher doses. 

It is important to note that 60 mg of fluoxetine showed a therapeutic effect, while 20 mg showed no difference compared to placebo (Fluoxetine Bulimia Nervosa Collaborative Study Group, 1992). There are no data at present to provide guidelines for the length of time that bulimic patients should stay on the antidepressant medication. 

Mitchell, J.E., Pyle R., and Eckert, E.D. (1990) A comparison study of antidepressants and structured intensive group psychotherapy in the treatment of bulimia nervosa. Arch Gen Psychiatry 47 149-157. 

Walsh, B., Hadigan, C, Devlin, M., and Gladis, M. (1991) Longterm outcome of antidepressants treatment for bulimia nervosa. Am Psychiatry 148 1206-1212. 

Pope and colleagues (519) published the first double-blind, placebo-controlled trial demonstrating the efficacy of antidepressants in bulimia nervosa. They found 200 mg per day of imipramine significantly superior to placebo in decreasing the following ... 

The role of medication in the treatment of bulimia nervosa seems better established than its role in the treatment of anorexia nervosa. The American Psychiatric Association Practice Guideline for Eating Disorders ( 510) suggests that antidepressants may be useful in bulimia nervosa with or without depression. They may be particularly helpful, however, in those with depression, anxiety, obsessions, or who have failed psychosocial therapies. 

Agras WS, McCann U. The efficacy and role of antidepressants in the treatment of bulimia nervosa. Ann Behav Med 1987 9 18-22. 

Walsh BT, Hadigan CM, Devlin MJ, etal. Long-term outcome of antidepressive treatment for bulimia nervosa. Am J Psychiatry 1991 148 1206-1212. 

In addition to the treatment of depression, the Food and Drug Administration (FDA) has approved the (on-label) use of the antidepressants for treatment of panic disorders, obsessive-compulsive disorders, bulimia nervosa, social phobia, and generalized anxiety disorder. And although not the treatment of choice, the tricyclics are sometimes used for enuresis—bed wetting. 

Therapeutic uses The primary indication for fluoxetine is depression, where it is as effective as the tricyclic antidepressants. Fluoxetine is effective in treating bulimia nervosa and obsessive-compulsive disorder. The drug has been used for a variety of other indications, including anorexia nervosa, panic disorder, pain associated with diabetic neuropathy, and for premenstrual syndrome. 

Adults with bulimia nervosa may be offered a trial with an antidepressant drug. Patients should be informed that antidepressant drugs can reduce the frequency of binge eating and purging. Selective serotonin reuptake inhibitors (SSRIs), and specifically fluoxetine, are the drugs of first choice for the treatment of bulimia... 

SSRIs are effective in milder cases of the eating disorder bulimia nervosa, particularly fluoxetine (in higher doses than are required for depression). This effect is independent of that on depression (which may co-exist) and may therefore involve action on transmitter systems other than those involved in modulating depression. Antidepressants appear to be ineffective in anorexia nervosa. 

Of 279 patients who presented to a hospital emergency service between 1994 and 1998 with a first tonic-clonic seizure, 17 (6.1%) had seizures that were thought to be drug-related (5). The most common drug-induced causes were cocaine intoxication (6/17) and benzodiazepine withdrawal (5/17) followed by amfebutamone use (4/17). While one amfebutamone-associated seizure occurred in a 26-year-old woman without any other risk factors, the three other patients (all women) had additional risk factors, such as concomitant treatment with antidepressants that also lower seizure threshold and a history of bulimia nervosa. These results suggest that amfebutamone is not an infrequent cause of de novo seizures. However, because of the time frame of the study, many of the patients would have been taking standard-release amfebutamone. It would be of interest to repeat the study now that modified-release amfebutamone is available. 

The antidepressant drug fluoxetine Prozac), another compound which promotes serotonergic neurotransmission in the brain, was also shown to reduce appetite and food intake in healthy volunteers (McGuirk and Sil-verstone 1990). It can be effective in the management of binge eating syndrome (see Chapter 6) and bulimia nervosa (see Chapter 5). Its use in uncomplicated obesity is more limited, as any beneficial effect wears off within a few months (Goldstein et al. 1994). 

Bacaltchuk, J. and P. Hay (2003). Antidepressants versus placebo for people with bulimia nervosa. Cochrane Database Syst Rev (4) CD003391. 

SAD and bulimia nervosa are often co-morbid, and both independently can show a seasonal pattern (Ghadirian et al. 1999). Also, they both respond favourably to SSRI antidepressant drugs. It may be that both disorders reflect similar alterations in central serotonin neurotransmission (Sil-verstone 1993). 

Tricyclic amine antidepressants (TCAs) are nonselective5-HT and NE reuptake inhibitors. Two TCAs, imipramine (20) and desi-pramine (21), are used to treat bulimia nervosa, primarily as second-line therapies. Imipramine, a tertiary amine, is a 5-HT re-uptake inhibitor with weak NE reuptake activity. Desipramine, a secondary amine and the des-ethyl analog of imipramine, is a NE reuptake inhibitor. Other TCAs used less frequently to treat BN include amitriptyline (22) and its N-desmethyl analog nortripyline (23). 

Bacaltchuk J, Hay R Review Antidepressants increase remission and clinical improvement in bulimia nervosa. Cochrane Database Syst Rev 2001 4 CD003391. 

Bacaltchuk J, Trefiglio RP, de Oliveira R, et al. Antidepressants versus psychotherapy for bulimia nervosa A systematic review. J Clin Pharm Ther 1999 24 23-31. 

In addition, it exerts beneficial effects in many disorders as an adjuvant to other treatment modalities. Such effects are apparent only if it is administered to an already pharmacologically treated patient. For example, in unresponsive major depressive disorder, the co-administration of lithium to an ongoing antidepressant treatment increases the response rate by up to 50%. In most cases, the response to lithium augmentation is either considerable or not at all ( all-or-none phenomenon). Some (currently not convincing) results have also been reported in unipolar depression, bulimia nervosa, and attention deficit hyperactivity disorder (ADHD). Lithium also exerts antiaggressive effects in conduct disorder, independent of any mood disorder, and can reduce behavioral dyscontrol and self-mutilation in mentally retarded patients. One of the most striking effects of lithium is its antisuicidal effect in patients who suffer from bipolar and unipolar depressive disorder irrespective of comorbid axis I disorder. ... 

Some antidepressants are used for other problems, e.g. anxiety disorders, bulimia nervosa, chronic paia... 

Fluoxetine (trade names Sarafem (Warner Chilcott Laboratories, Dublin, Ireland), Prozac (Eli Lilly, Indianapolis, IN), Fontex (Eli Lilly), etc.) is an antidepressant of the selective serotonin reuptake inhibitor approved for the treatment of major depression, bulimia nervosa, panic... 

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