Bulimia nervosa management

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). 

Methylphenidate Stimulants, such as methylphenidate and amphetamine, are widely used in the management of attention deficit hyperactivity disorder (ADHD). Such drugs have long been known to reduce hunger, but have not been generally recommended for treatment of BN. A few patients who have symptoms of bulimia nervosa plus some co-morbid features of ADHD have noted that the addition of methylphenidate or amphetamine markedly reduced the frequency of binge eating (Drimmer 2003). 

Health, N. C. C. f. M. (2003). Eating Disorders Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. London, UK, British Psychological Society. 

Phenelzine is a hydrazine MAOl (Fig. 21.25). Its mechanism of action is the prolonged, nonselective, irreversible inhibition of MAO. Phenelzine has been used with some success in the management of bulimia nervosa. The MAOIs, however, are potentially dangerous in patients with binge eating and purging behaviors, and the American Psychiatric Association states that MAOIs should be used with caution in the management of bulimia nervosa. 

---