Imipramine and diet counseling with psychological support in the treatmentof obese binge eaters: A randomized, placebo-controlled double-blind study

Objective: This study with 31 obese binge eaters (body mass index [BMI] 39. 5 +/- 8.6 kg/m(2) [SD]) was designed to assess whether diet counseling with psychological support and imipramine or placebo has an effect on the frequ ency of binge eating, body weight, and depression during an 8-week treatmen t phase. This was followed by an open medication-free phase of 6 months of continuous diet counseling with psychological support. Methods: Randomized double-blind placebo-controlled study of 8 weeks followed by an open phase of 6 months. Patients were evaluated in medical visits by a semistructured videotaped interview, psychometric questionnaires, and hematochemical param eters. Results: From Week 0 to 8, a significant reduction in binge frequenc y occurred in both treatment conditions (7.1 +/- 4.1 to 2.8 +/- 3.0 binges per week [imipramine] vs. 7.1 +/- 4.1 to 5.4 +/- 5.7 [placebo], p < .01). P atients on imipramine lost -2.2 +/- 1.8 kg compared to placebo-treated subj ects (+0.2 +/- 3.3 kg, p < .001). On follow-up, only the patients initially treated with imipramine continued to lose weight (-5.1 +/- 2.8 kg [imipram ine] vs. 2.2 +/- 6.8 kg [placebo], p < .001 [differences to Week 0]). While both treatment conditions were associated with significant improvements on a rater's measure of depressive symptoms (Hamilton Depression Scale) at We ek 8, only the patients treated with imipramine still showed a significant improvement at Week 32. Scores on the Self Depression Rating Scale did not show a group difference but a significant reduction at Weeks 8 and 32, comp ared to baseline. Discussion: These results suggest that adding low-dose im ipramine to diet counseling with psychological support helps patients losin g weight even for at least 6 months off medication. The effect might includ e a psychological priming of weight loss during the double-blind phase that continues at least for half a year after stopping the drug. (C) 1999 by Jo hn Wiley & Sons, Inc.