A Cochrane review [Abstract] 1 included 19 trials comparing antidepressants with placebo: 6 trials with TCAs (imipramine, desipramine and amitriptyline), 5 with SSRIs (fluoxetine), 5 with MAOIs (phenelzine, isocarboxazid, moclobemide and brofaromine) and 3 with other classes of drugs (mianserin, trazodone and bupropion). Similar results were obtained in terms of efficacy for these different groups of drugs.
The pooled RR for remission of binge episodes was 0.87 (95% CI 0.81-0.93; p<0.001) favouring drugs. The NNT for a mean treatment duration of 8 weeks, taking the non-remission rate in the placebo controls of 92% as a measure of the baseline risk was 9 (95% CI 6-16). The RR for clinical improvement, defined as a reduction of 50% or more in binge episodes was 0.63 (95% CI 0.55-0.74), and the NNT for a mean treatment duration of 9 weeks was 4 (95% CI 3-6) with a non-improvement rate of 67% in the placebo group. Drop-out rates were higher for TCA than for placebo, but lower for fluoxetine.
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