Combination of antidepressants and psychological treatments for bulimia nervosa: a systematic review

Background: This review assessed the effect of a combination of antidepressants plus psychological approaches compared to each single treatment for bulimia nervosa. Method: Trials were included in two meta-analyses: single antidepressants versus combination and single psychological approaches versus combination. Methodological quality and homogeneity of results were assessed. Dichotomous outcomes were analysed by calculating relative risks (RR). Results: Five trials were included in meta-analysis I and 7 in meta-analysis 2. Remission rates were 42% for combination versus 23% for antidepressants (RR = 1.38; 95% CI = 0.98-1.93; P = 0.06) and 36% for psychological approaches compared to 49% for combination (RR = 1.21; P = 0.03). Drop-out rates were 16% for psychological approaches and 30% for combination (RR = 0.57; 95% CI = 0.38-0.088; P = 0.11). Conclusion: Efficacy of combined treatments was superior to single approaches. When antidepressants were combined to treatment, acceptability of psychological approaches was significantly reduced.