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Review: antidepressants increase remission and clinical improvement in bulimia nervosa

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 QUESTION: In patients with bulimia nervosa (BN), are antidepressants effective for increasing remission and clinical improvement?

Data sources

Studies were identified by searching Medline; EMBASE/Excerpta Medica; LILACS; PsycLIT; SCISEARCH; the Cochrane Depression, Anxiety, and Neurosis Group Database of Trials; the Cochrane Controlled Trials Register; Clinical Evidence; and reference lists. The International Journal of Eating Disorders was also hand searched, and authors and pharmaceutical companies were contacted.

Study selection

Studies were selected if they were randomised controlled trials (RCTs) that compared any antidepressant with placebo for ≥ 4 weeks in patients with BN. RCTs were excluded if patients had binge-eating or purging-type anorexia nervosa or binge-eating disorder.

Data extraction

2 reviewers assessed the quality of RCTs and extracted data on patients, study characteristics, drug regimens, and outcomes (including remission [100% reduction in binge or purge episodes], clinical improvement [≥ 50% reduction in binge or purge episodes], and drop outs).

Main results

16 RCTs (1300 patients) met the selection criteria. Any antidepressant was better than placebo for increasing remission at a mean follow …

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  • Source of funding: not stated.

  • For correspondence: Dr J Bacaltchuk, Universidade Federal de São Paulo, São Paulo—SP, Brazil. bacaltc{at}

  • Abstract and commentary also appear in Evidence-Based Mental Health.