Antidepressant medication in the treatment of bulimia nervosa

Antidepressant therapy has been shown to be efficacious in the treatment of bulimia nervosa, a serious eating disorder that can be associated with substantial morbidity and mortality. Seven antidepressant drugs have been tested in double-blind, placebo-controlled studies. Five of these studies demonstrated strongly positive findings, one a weakly positive finding, and one a negative finding. However, inadequate doses of medication may have been used in the latter two studies. In all of the positive studies, antidepressant agents appeared effective even in bulimic subjects who did not display concomitant depression, indicating that this treatment modality should not be reserved only for depressed bulimic patients. Although not yet tested in double-blind studies, trazodone also appears effective in the treatment of bulimia nervosa. Results from one large open study suggested that trazodone has comparable efficacy to the tricyclic antidepressant agents. Trazodone would be a particularly attractive treatment for bulimia nervosa because of its low anticholinergic side-effects profile; placebo-controlled studies are required, however, before definitive recommendations can be made.