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Review: psychological treatment is as effective as antidepressants for bulimia nervosa, but a combination is best

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 QUESTION: In patients with bulimia nervosa (BN), are antidepressants as effective as psychological treatment (PT) for increasing remission and clinical improvement rates? Is a combination of antidepressants and PT better than each intervention alone?

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 and book chapters on BN were also hand searched, and authors and pharmaceutical companies were contacted.

Study selection

Studies were selected if they were randomised controlled trials (RCTs) that compared antidepressants with PT in patients with BN. Studies were excluded if patients had binge-eating or purging-type anorexia nervosa or binge-eating disorder.

Data extraction

2 reviewers assessed the quality of studies and extracted data on patients, study characteristics, interventions, 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

5 RCTs (237 patients) compared antidepressants with PT. Groups did not differ significantly for remission (5 RCTs); only 1 RCT reported on clinical improvement. More drop outs occurred in the antidepressant …

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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.