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Evidence summaries

Antidepressants and Psychological Treatments for Bulimia Nervosa

A combination of antidepressants and psychotherapy may be more effective than psychotherapy alone, but psychotherapy appeared to be more acceptable to subjects. There was a non-significant trend favouring single psychoterapy over single antidepressants. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 17 studies. All participants were patients with purging type bulimia nervosa. Those with severe comorbid depression, obesity and substance abuse were usually excluded from the trials. Patients were recruited through advertising in the majority of studies.Five trials were included in comparison one (antidepressants versus psychological treatments), five in comparison two (antidepressants versus the combination) and seven in comparison three (psychological treatment versus the combination). Remission rates were 20% for single antidepressants compared to 39% for single psychotherapy (RR 1.28, 95% CI 0.98 to 1.67). Dropout rates were higher for antidepressants than for psychotherapy (RR 2.18, 95% CI 1.09 to 4.35). Comparison two found remission rates of 42% for the combination versus 23% for antidepressants (RR 1.38, 95% CI 0.98 to 1.93. Combination three showed a 36% pooled remission rate for the the psychological approaches compared to 49% for the combination (RR 1.21, 95% CI 1.02 to 1.45, NNT for a mean treatment duration of 15 weeks was 8, 95% CI 4 to 320).

Comment: The quality of evidence is downgraded by sparse data (small number of patients in individual comparisons) and indirecness of evidence (highly selected participants).

References

  • Bacaltchuk J, Hay P, Trefiglio R. Antidepressants versus psychological treatments and their combination for bulimia nervosa. Cochrane Database Syst Rev 2001;(4):CD003385. [PubMed]

Primary/Secondary Keywords