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Am J Psychiatry 1992; 149:82-87
Copyright © 1992 by American Psychiatric Association
Pharmacologic and cognitive-behavioral treatment for bulimia nervosa: a controlled comparison
WS Agras, EM Rossiter, B Arnow, JA Schneider, CF Telch, SD Raeburn, B Bruce, M Perl and LM Koran
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305-5490.
OBJECTIVE: This study examined the relative effectiveness of desipramine,
cognitive-behavioral therapy, and their combination in the treatment of
bulimia nervosa, together with the effects of withdrawing medication after
two different lengths of treatment. METHOD: Seventy- one patients meeting
DSM-III-R criteria for bulimia nervosa, recruited from an eating disorders
clinic or by advertisements, were assigned at random to one of five groups:
desipramine (withdrawn at 16 or 24 weeks), combined treatment (medication
withdrawn at 16 or 24 weeks), and cognitive-behavioral therapy (15
sessions). All treatments were conducted individually in an outpatient
clinic. The primary outcome measures were binge eating and purging rates
assessed at pretreatment, 16, 24, and 32 weeks. The results were analyzed
as three groups (medication, cognitive-behavioral therapy, and combined
treatment) at 16 weeks and as five groups at subsequent assessments.
RESULTS: At 16 weeks, both cognitive-behavioral therapy and the combined
treatment were superior to medication given for 16 weeks in reducing binge
eating and purging. At 32 weeks, however, only the combined 24-week
treatment was superior to medication given for 16 weeks. The combined
treatment was also more effective in reducing dietary preoccupation and
hunger. Continuing cognitive-behavioral therapy appeared to prevent relapse
in patients withdrawn from medication at 16 weeks. CONCLUSIONS: Overall,
the results favor the use of a combination of medication and cognitive-
behavioral therapy in the treatment of bulimia nervosa, with medication
continued for at least 24 weeks.
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