A double-blind placebo-controlled comparison of phenelzine and imipramine in the treatment of bulimia in atypical depressives

Abstract

Although antidepressants have been found to be superior to placebo in 12 of 14 studies, the relationship between improvement in the depressive diathesis and bulimia is unclear. In this study, the efficacy of placebo, imipramine, and phenelzine is examined in patients comorbid for atypical depression and bulimia. Greater improvement was observed for both depressive and bulimic symptoms with phenelzine than with either imipramine or placebo. Consistent with its poor antidepressant effects in atypical depression, imipramine seemed to have minimal efficacy for the bulimic symptoms of atypical depressives. These data suggest that the presence of bulimia does not alter the treatment response of atypically depressed patients. Furthermore, the data may suggest a link between depression and bulimia in atypical depressives. Demonstrating a statistical difference with a small sample suggests the effect size is robust, however conclusions are limited by a small sample size. 0 1994 by )ohnWiley & Sons, lnc.

Efficacy of pharmacotherapies for bulimia nervosa: a systematic review and meta-analysis

“…These trials were used for at least one of the main comparisons. Studies included 6 types of drugs: 1. selective serotonin reuptake inhibitors (SSRIs): 10 studies compared fluoxetine with placebo: [ 39 , 43 , 44 , 46 – 50 , 52 , 53 ]; only two studies compared CBT plus fluoxetine with CBT to show the efficacy of fluoxetine [ 45 , 51 ] and citalopram versus placebo [ 54 ] and fluvoxamine [ 28 ]; 2. tricyclic antidepressants (TCA): lmipramine [ 59 – 62 ] and desipramine vs. placebo [ 63 , 66 ]; 2 studies compared CBT plus desipramine with CBT [ 64 , 65 ]; 3. monoamine oxidase inhibitors (MAOI): phenelzine [ 62 , 67 – 69 ], moclobemide [ 58 ], and brofaromine [ 71 ]; 4. Antiepileptic drugs: topiramate [ 41 , 55 , 56 ]; 5. mood stabilizer: lithium [ 70 ]; 6. methamphetamine-type appetite suppressant: fenfluramine [ 57 ].…”

“…If there were other intervention groups in the study, we only included the two groups of needed drugs and placebo, and the other groups were not considered, such as Grilo et al 2005 [ 46 ] and Sundblad et al 2005 [ 54 ]. Rothschild et al 1994 [ 62 ] divided the treatment into three groups of imipramine, phenelzine and placebo, and we analyzed the comparison between the two drugs and placebo.…”

“…Two studies [ 45 , 51 ] did not use a blinded protocol, so they were judged as high risk. For outcome data integrity, only three studies [ 47 , 52 , 62 ] were of unclear risk because they did not report the number or reasons for dropout. All studies had a low risk of selective reporting and no other bias.…”

“…When removing the two studies with CBT [ 45 , 51 ], the result did not change much. Concerning MAOIs (six trials [ 58 , 62 , 67 – 69 , 71 ], 111 participants in the experimental group and 120 in the control group), the SMD was -0.50 (95% CI -0.95 ~ -0.06), with 60% heterogeneity. If Carruba et al (2001) [ 58 ] were excluded, the heterogeneity declined to 3%, indicating that the study was research on moclobemide.…”

Efficacy of pharmacotherapies for bulimia nervosa: a systematic review and meta-analysis

“…These trials were used for at least one of the main comparisons. Studies included 6 types of drugs: 1. selective serotonin reuptake inhibitors (SSRIs): 10 studies compared fluoxetine with placebo: [ 39 , 43 , 44 , 46 – 50 , 52 , 53 ]; only two studies compared CBT plus fluoxetine with CBT to show the efficacy of fluoxetine [ 45 , 51 ] and citalopram versus placebo [ 54 ] and fluvoxamine [ 28 ]; 2. tricyclic antidepressants (TCA): lmipramine [ 59 – 62 ] and desipramine vs. placebo [ 63 , 66 ]; 2 studies compared CBT plus desipramine with CBT [ 64 , 65 ]; 3. monoamine oxidase inhibitors (MAOI): phenelzine [ 62 , 67 – 69 ], moclobemide [ 58 ], and brofaromine [ 71 ]; 4. Antiepileptic drugs: topiramate [ 41 , 55 , 56 ]; 5. mood stabilizer: lithium [ 70 ]; 6. methamphetamine-type appetite suppressant: fenfluramine [ 57 ].…”

“…If there were other intervention groups in the study, we only included the two groups of needed drugs and placebo, and the other groups were not considered, such as Grilo et al 2005 [ 46 ] and Sundblad et al 2005 [ 54 ]. Rothschild et al 1994 [ 62 ] divided the treatment into three groups of imipramine, phenelzine and placebo, and we analyzed the comparison between the two drugs and placebo.…”

“…Two studies [ 45 , 51 ] did not use a blinded protocol, so they were judged as high risk. For outcome data integrity, only three studies [ 47 , 52 , 62 ] were of unclear risk because they did not report the number or reasons for dropout. All studies had a low risk of selective reporting and no other bias.…”

“…When removing the two studies with CBT [ 45 , 51 ], the result did not change much. Concerning MAOIs (six trials [ 58 , 62 , 67 – 69 , 71 ], 111 participants in the experimental group and 120 in the control group), the SMD was -0.50 (95% CI -0.95 ~ -0.06), with 60% heterogeneity. If Carruba et al (2001) [ 58 ] were excluded, the heterogeneity declined to 3%, indicating that the study was research on moclobemide.…”

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

“…Two studies were multi‐centre, multinational [16,17], both comparing fluoxetine to placebo. Ten trials were conducted in the USA [18–27], two in Canada [28,29], one in the UK [30] and one in Norway [31]. Trials recruited outpatients seeking treatment ‘spontaneously’ from eating disorders clinics or programs, or included also volunteers for research recruited through advertisement.…”

Efficacy of pharmacotherapies for bulimia nervosa: a systematic review and meta-analysis

“…These trials were used for at least one of the main comparisons. Studies included 6 types of drugs: 1. selective serotonin reuptake inhibitors (SSRIs): 10 studies compared fluoxetine with placebo: [ 39 , 43 , 44 , 46 – 50 , 52 , 53 ]; only two studies compared CBT plus fluoxetine with CBT to show the efficacy of fluoxetine [ 45 , 51 ] and citalopram versus placebo [ 54 ] and fluvoxamine [ 28 ]; 2. tricyclic antidepressants (TCA): lmipramine [ 59 – 62 ] and desipramine vs. placebo [ 63 , 66 ]; 2 studies compared CBT plus desipramine with CBT [ 64 , 65 ]; 3. monoamine oxidase inhibitors (MAOI): phenelzine [ 62 , 67 – 69 ], moclobemide [ 58 ], and brofaromine [ 71 ]; 4. Antiepileptic drugs: topiramate [ 41 , 55 , 56 ]; 5. mood stabilizer: lithium [ 70 ]; 6. methamphetamine-type appetite suppressant: fenfluramine [ 57 ].…”

“…If there were other intervention groups in the study, we only included the two groups of needed drugs and placebo, and the other groups were not considered, such as Grilo et al 2005 [ 46 ] and Sundblad et al 2005 [ 54 ]. Rothschild et al 1994 [ 62 ] divided the treatment into three groups of imipramine, phenelzine and placebo, and we analyzed the comparison between the two drugs and placebo.…”

“…Two studies [ 45 , 51 ] did not use a blinded protocol, so they were judged as high risk. For outcome data integrity, only three studies [ 47 , 52 , 62 ] were of unclear risk because they did not report the number or reasons for dropout. All studies had a low risk of selective reporting and no other bias.…”

“…When removing the two studies with CBT [ 45 , 51 ], the result did not change much. Concerning MAOIs (six trials [ 58 , 62 , 67 – 69 , 71 ], 111 participants in the experimental group and 120 in the control group), the SMD was -0.50 (95% CI -0.95 ~ -0.06), with 60% heterogeneity. If Carruba et al (2001) [ 58 ] were excluded, the heterogeneity declined to 3%, indicating that the study was research on moclobemide.…”

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

“…Two studies were multi‐centre, multinational [16,17], both comparing fluoxetine to placebo. Ten trials were conducted in the USA [18–27], two in Canada [28,29], one in the UK [30] and one in Norway [31]. Trials recruited outpatients seeking treatment ‘spontaneously’ from eating disorders clinics or programs, or included also volunteers for research recruited through advertisement.…”

Efficacy of pharmacotherapies for bulimia nervosa: a systematic review and meta-analysis

“…These trials were used for at least one of the main comparisons. Studies included 6 types of drugs: 1. selective serotonin reuptake inhibitors (SSRIs): 10 studies compared fluoxetine with placebo: [ 39 , 43 , 44 , 46 – 50 , 52 , 53 ]; only two studies compared CBT plus fluoxetine with CBT to show the efficacy of fluoxetine [ 45 , 51 ] and citalopram versus placebo [ 54 ] and fluvoxamine [ 28 ]; 2. tricyclic antidepressants (TCA): lmipramine [ 59 – 62 ] and desipramine vs. placebo [ 63 , 66 ]; 2 studies compared CBT plus desipramine with CBT [ 64 , 65 ]; 3. monoamine oxidase inhibitors (MAOI): phenelzine [ 62 , 67 – 69 ], moclobemide [ 58 ], and brofaromine [ 71 ]; 4. Antiepileptic drugs: topiramate [ 41 , 55 , 56 ]; 5. mood stabilizer: lithium [ 70 ]; 6. methamphetamine-type appetite suppressant: fenfluramine [ 57 ].…”

“…If there were other intervention groups in the study, we only included the two groups of needed drugs and placebo, and the other groups were not considered, such as Grilo et al 2005 [ 46 ] and Sundblad et al 2005 [ 54 ]. Rothschild et al 1994 [ 62 ] divided the treatment into three groups of imipramine, phenelzine and placebo, and we analyzed the comparison between the two drugs and placebo.…”

“…Two studies [ 45 , 51 ] did not use a blinded protocol, so they were judged as high risk. For outcome data integrity, only three studies [ 47 , 52 , 62 ] were of unclear risk because they did not report the number or reasons for dropout. All studies had a low risk of selective reporting and no other bias.…”

“…When removing the two studies with CBT [ 45 , 51 ], the result did not change much. Concerning MAOIs (six trials [ 58 , 62 , 67 – 69 , 71 ], 111 participants in the experimental group and 120 in the control group), the SMD was -0.50 (95% CI -0.95 ~ -0.06), with 60% heterogeneity. If Carruba et al (2001) [ 58 ] were excluded, the heterogeneity declined to 3%, indicating that the study was research on moclobemide.…”

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

“…Two studies were multi‐centre, multinational [16,17], both comparing fluoxetine to placebo. Ten trials were conducted in the USA [18–27], two in Canada [28,29], one in the UK [30] and one in Norway [31]. Trials recruited outpatients seeking treatment ‘spontaneously’ from eating disorders clinics or programs, or included also volunteers for research recruited through advertisement.…”