Am J Psychiatry 1993; 150:770-774
Copyright © 1993 by American Psychiatric Association
Pharmacotherapy of bulimia nervosa with fluoxetine: assessment of clinically significant attitudinal change
DS Goldbloom and MP Olmsted
Department of Psychiatry, Toronto Hospital, Ont., Canada.
OBJECTIVE: The authors used an individual change model to examine the
clinically significant effect of pharmacotherapy with fluoxetine on the
attitudes and beliefs characteristic of bulimia nervosa. METHOD: Three
hundred eighty-two women meeting DSM-III-R criteria for bulimia nervosa
participated in a multicenter, double-blind, randomized clinical trial of
placebo, 20 mg of fluoxetine, and 60 mg of fluoxetine for 8 weeks.
Behavioral change was assessed with self-monitored measures of binge eating
and purging, and psychological change was measured with the self- rating
Eating Disorder Inventory and the Hamilton Rating Scale for Depression. A
specific statistical method was used to determine clinically significant
change in psychological measures. RESULTS: On the majority of psychological
measures, more of the subjects receiving active drug than those receiving
placebo showed clinically significant change. Behavioral improvement was
significantly associated with the likelihood of demonstrating clinically
significant psychological change. The observed effect of pharmacotherapy on
attitudinal change was not related to the presence of depression at
baseline. These results compare favorably with other interventions for
bulimia nervosa. CONCLUSIONS: Measures of change in treatment studies
should reflect clinical as well as statistical significance. In the
short-term, treatment of bulimia nervosa with fluoxetine appears to produce
clinically significant attitudinal and behavioral changes.
