The treatment of bulimia nervosa

Research into the treatment of bulimia nervosa began only 15 years ago following an upsurge of patients with the disorder in clinics throughout the Western world. Substantial progress has been made during this time. Antidepressant medications, including the tricyclic antidepressants, monoamine oxidase inhibitors and serotonin reuptake inhibitors, have all been demonstrated to be effective in placebo-controlled trials. In the case of fluoxetine, 60 mg/day has been more effective than 20 mg/day. Cognitive-behavioral therapy, with a focus on normalizing food intake and challenging distorted food rules and perceptions of body shape, has proven the most effective psychotherapeutic approach to treatment, although interpersonal therapy may also be effective. Cognitive-behavioral therapy is more effective than antidepressant medication in the treatment of bulimia nervosa, while the combination of both therapies is probably marginally superior to cognitive-behavioral therapy alone. From a cost perspective, antidepressant medication given for at least 6 months is significantly less expensive in terms of cost per recovered patient than cognitive-behavioral therapy. Hence, it is suggested that the primary practitioner use a combination of a self-help manual plus medication, and if this treatment fails refer to a specialist for further treatment with cognitive-behavioral therapy with or without a further medication trial.