PHARMACOTHERAPY OF BULIMIA-NERVOSA AND BINGE-EATING DISORDER - LONGER-TERM OUTCOMES

The longer-term effects of antidepressant medication, with and without the addition of psychotherapy, for the treatment of bulimia nervosa a nd binge eating disorder are reviewed. The use of a single antidepress ant agent results in recovery of about 25 percent of patients entering treatment; continued treatment is accompanied by relapse in about one -third of these patients. Substituting one or more antidepressants for the initial agent in patients who fail to improve or cannot tolerate side effects improves long-term maintenance. Adding cognitive-behavior al therapy (CBT) may prevent relapse once medication is discontinued, and the combination of CBT and antidepressant treatment is more effect ive than a single medication. There is also evidence that antidepressa nt treatment combined with CBT is more effective than placebo plus CBT . The problem of how to sequence medication and CBT has not been resol ved, although a recent study demonstrating that pharmacotherapy is mor e cost-effective than CBT suggests that treatment might begin with med ication.