Antidepressants versus placebo for the treatment of bulimia nervosa: a systematic review

Objective: The objective of this study was to valuate the effectiveness, tolerability and acceptability of various classes of antidepressants compared with placebo in the treatment of bulimia nervosa. Method: A meta-analysis including 16 randomised controlled trials and 1300 bulimic patients was performed. Dichotomous outcomes were analysed by calculating relative risks, and continuous outcomes by calculating effect sizes. Methodological quality, heterogeneity in the results and selective publication were assessed. Results: Short-term remission in bulimic symptoms was statistically more likely on antidepressants than placebo (Relative Risk = 0.88, 95% CI = 0.83-0.94, p < 0.0001). Drop-out rates were high but no statistical difference was found between treatment groups (34.6% and 31.4% for drug and placebo; RR = 1.03, 95% CI = 0.80-1.32, p = 0.8). No difference in efficacy could be demonstrated among different classes of antidepressants. Conclusions: The use of a single antidepressant agent was clinically effective for the treatment of bulimia nervosa when compared with placebo, with an overall greater remission rate and a higher rate of drop-outs. No differential effect regarding efficacy and tolerability among the various classes of antidepressants could be demonstrated.