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Am J Psychiatry 1997; 154:523-531
Copyright © 1997 by American Psychiatric Association
Medication and psychotherapy in the treatment of bulimia nervosa
BT Walsh, GT Wilson, KL Loeb, MJ Devlin, KM Pike, SP Roose, J Fleiss and C Waternaux
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA.
OBJECTIVE: Two treatments for bulimia nervosa have emerged as having
established efficacy: cognitive-behavioral therapy and antidepressant
medication. This study sought to address 1) how the efficacy of a
psychodynamically oriented supportive psychotherapy compared to that of
cognitive-behavioral therapy; 2) whether a two-stage medication
intervention, in which a second antidepressant (fluoxetine) was employed if
the first (desipramine) was either ineffective or poorly tolerated, added
to the benefit of psychological treatment; and 3) if the combination of
medication and psychological treatment was superior to a course of
medication alone. METHOD: A total of 120 women with bulimia nervosa
participated in a randomized, placebo-controlled trial. RESULTS:
Cognitive-behavioral therapy was superior to supportive psychotherapy in
reducing behavioral symptoms of bulimia nervosa (binge eating and
vomiting). Patients receiving medication in combination with psychological
treatment experienced greater improvement in binge eating and depression
than did patients receiving placebo and psychological treatment. In
addition, cognitive-behavioral therapy plus medication was superior to
medication alone, but supportive psychotherapy plus medication was not.
CONCLUSIONS: At present, cognitive-behavioral therapy is the psychological
treatment of choice for bulimia nervosa. A two-stage medication
intervention using fluoxetine adds modestly to the benefit of psychological
treatment.
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