Antidepressants versus psychotherapy for bulimia nervosa: a systematic review

Objective: To assess the efficacy and acceptability of antidepressants comp ared to psychotherapy as single approaches for the treatment of bulimia ner vosa. Method: Dichotomous outcomes were analysed by calculating relative ri sks and continuous outcomes by calculating effect sizes. The number needed to treat (or harm) was calculated. Methodological quality of trials and het erogeneity in the results were evaluated. Results: A meta-analysis including five randomized controlled trials showed a non-significant difference in short-term remission of bulimic symptoms f avouring psychotherapy. Remission rates were 20% for antidepressants and 39 % for psychotherapy (P = 0.07). Dropout rates were higher (P = 0.027) for a ntidepressants (40%) than for psychotherapy (18%). The number needed to har m (NNH) was 4. Discussion: Psychotherapy was superior to antidepressants, but using a more conservative statistical approach this difference, although clinically rel evant, was not significant. The number of trials might be insufficient to s how the significance of a 20% absolute risk reduction in efficacy. Psychoth erapy was a better accepted treatment.