Pharmacotherapy of Bulimia Nervosa

This review article summarizes the progress that has been made over the past 14 years in the drug treatment of bulimia nervosa, an eating disorder characterized by recurrent binge eating and purging that has continued for 3 months with a regularity of at least twice a week. This recently described eating disorder has been the subject of intensive research scrutiny with regard to both pharmacotherapy and psychotherapy, and results indicate a role for both types of treatment. The linkage of bulimia to major depressive illness is reflected in the overlap that is seen in neurotransmitter dysregulations--including similarities in serotonin disturbances--as well as in shared symptomatology, longitudinal risk and comorbidity, and prominent history of affective illness in the families of bulimic probands. The observed relationship between these disorders acted as a catalyst for the early pharmacotherapy studies documenting the use of antidepressant medications in the treatment of bulimia. Among the drugs documented to reduce bulimia are tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors. The sequencing and integration of pharmacotherapy and psychotherapy require further study, but current research has yielded a variety of therapeutic options for the clinician to reduce both the disturbed eating behavior and the dysfunctional eating attitudes of patients with bulimia nervosa.