Eating Disorders - Treatment for Bulimia

(Page 2)

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluvoxamine (Luvox)

Studies are mixed, however, on whether SSRIs offer an additional advantage in reducing binge-eating compared to CBT. Prozac has been approved for bulimia and is considered the drug of choice, although some studies suggest that other SSRIs, such as Luvox, may be even more effective.

Important note: Recent studies indicate that the use of Prozac and other antidepressants may cause children and teenagers to have suicidal thoughts. Children who are taking these drugs must be monitored very carefully for signs of potential suicidal behavior.

If the drugs are not effective, the doctor should be sure it is not because the patient is vomiting after taking the medication. Some experts believe that these drugs should be continued even after symptoms have improved in order to restore healthy brain chemical balances.

Other Drug Therapy for Bulimia Nervosa

Drugs to Prevent Vomiting. In one study, ondansetron (Zofran), a drug that prevents vomiting, reduced the binge-purge episodes by half. The drug may cause depression in people already on SSRI antidepressants. More studies are needed.

Sibutramine. Sibutramine (Meridia) is a drug used for weight loss. It does so by balancing two important brain chemicals, serotonin and norepinephrine, which helps to increase metabolism. Some evidence suggests that the actions of this drug may be useful for people who binge. However, this drug should be used only for patients with bulimia who have normal or above normal weight, and should never be used for those who are anorexic.

Inositol. Inositol is a B vitamin that is being investigated for bipolar disorder, anxiety, and depression. A 2001 study suggests that it may also have benefits for bulimic patients.

Topiramate. The antiepileptic drug topiramate (Topamax) has been shown in studies to reduce bingeing and purging episodes in bulimics, as well as to improve self-esteem, attitudes, and body image.

Alternative Approaches to Bulimia

Hypnosis. A study on women with bulimia showed that they had a high susceptibility to hypnosis, suggesting that it might be beneficial as part of their treatment. People with anorexia, on the other hand, seem to be very resistant to the state of vulnerability required in this process.

Light Therapy. Some researchers have noted an association between bulimia and seasonal affective disorder (depression that intensifies in the darker winter months). This suggests that therapy using intense directed light may be useful. Studies report, however, that while light therapy relieves depression, it has little effect on binge-purging behavior. Some experts suggest it may be more useful in combination with medication and psychotherapy.

Guided Imagery. A technique called guided imagery reduced frequency of binges and vomiting by almost 75% in one study. This method uses audiotapes to evoke images that will reduce stress and help achieve specific goals.

Review Date: 12/13/2006
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.