Am J Psychiatry 1991; 148:1206-1212
Copyright © 1991 by American Psychiatric Association
Long-term outcome of antidepressant treatment for bulimia nervosa
BT Walsh, CM Hadigan, MJ Devlin, M Gladis and SP Roose
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032.
OBJECTIVE: The purpose of this study was 1) to replicate previous work
indicating that antidepressant medication is superior to placebo in the
treatment of bulimia nervosa and 2) to assess the long-term efficacy of
this form of treatment. METHOD: Eighty patients entered a three-phase
treatment protocol. An 8-week double-blind initiation phase was used to
compare the effects of desipramine and placebo. Patients who responded
satisfactorily to desipramine entered a 16-week maintenance phase. Patients
who remained well were then randomly assigned to either desipramine or
placebo for 6 additional months (discontinuation phase). The primary
outcome measure was binge frequency, which was assessed weekly by
self-report diaries. RESULTS: In the initiation phase the superiority of
desipramine over placebo in reducing binge frequency was demonstrated.
Patients treated with desipramine had a mean reduction in binge frequency
of 47% at termination, whereas patients taking placebo experienced a mean
increase of 7%. Less than half of the patients treated with desipramine met
the criteria for entering the maintenance phase, and 29% of the patients
entering that phase relapsed in the following 4 months. There were not
enough patients in the discontinuation phase to permit clear conclusions
about the need for continued antidepressant medication after 6 months of
treatment. CONCLUSIONS: The study documents a beneficial effect of
desipramine in the treatment of bulimia nervosa when compared to placebo.
However, limited improvement and considerable relapse with continued
treatment suggest serious limitations to the long-term efficacy of a single
antidepressant trial in treating bulimia nervosa.
