INTENSIVE NUTRITIONAL COUNSELING IN BULIMIA-NERVOSA - A ROLE FOR SUPPLEMENTATION WITH FLUOXETINE

Objective: The aims of the paper are to determine whether nutritional counselling is associated with an improvement in bulimic symptomatolog y, whether this improvement is maintained during post-treatment follow -up, and whether the addition of fluoxetine 3 x 20 mg/day confers addi tional benefit. Method: Psychological, pharmacological and combined ps ychopharmacological treatments of bulimia nervosa were reviewed briefl y. Sixty-seven patients referred to specialist eating disorder service s who fulfilled strict diagnostic criteria were treated with intensive nutritional counselling and randomly assigned to either fluoxetine 3 x 20 mg/day or placebo. After a I-week 'wash-out', active treatment wa s given over 8 weeks, followed by post-treatment interviews at 12 and 20 weeks. Results: Both groups of patients improved significantly duri ng treatment. In some respects, the fluoxetine group did slightly bett er as demonstrated by the items 'restraint', 'weight concern' and 'sha pe concern' (p<0.05 vs p<0.0001) on the Eating Disorder Examination (E DE). Fluoxetine patients decreased their energy intake and lost a mode st amount of weight. They went on to regain weight during the follow-u p period, returning to levels higher than they were initially. These p atients also appeared more likely to have a recurrence of symptoms, as shown by the fall in percentage of binge-free patients and by changes in the EDE. Conclusion: Nutritional counselling is an effective means of treating bulimia nervosa, with improvement maintained up to 3 mont hs follow-up. The addition of fluoxetine may confer some benefit durin g active treatment, but its discontinuation may contribute to a higher rate of recurrence of symptoms post treatment. Of course, this study cannot be extrapolated to the efficacy of fluoxetine when used as the only form of treatment in patients for whom intensive nutritional coun selling or other structured psychological programs are not available.