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

Abstract

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.

Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses

“…1. Out of 884 articles, 55 MAs and 4 NMAs were included (Albano et al, 2019;Bacaltchuk et al, 1999;Josue Josué Bacaltchuk et al, 2000;Josue Bacaltchuk et al, 2000;Josué Josue Bacaltchuk et al, 2000;Josué Bacaltchuk et al, 2000;Bacaltchuk and Hay, 2003;Barakat et al, 2019;Berkman et al, 2015;Brownley et al, 2016;Cassioli et al, 2020;Claudino et al, 2006;Couturier et al, 2013;Cuijpers et al, 2016;de Vos et al, 2014;Dold et al, 2015;Fisher et al, 2018Fisher et al, , 2010Fornaro et al, 2016;Ghaderi et al, 2018;Ghaderi and Andersson, 1999;Grenon et al, 2018a;Hagan et al, 2020;Hasselbalch et al, 2020;Hay et al, 2019Hay et al, , 2015Hay et al, , 2004Hay et al, , 2001Hay et al, , 2009Hilbert et al, 2019;Kishi et al, 2012;Lebow et al, 2013;Linardon, 2018b;Linardon et al, 2020Linardon et al, , 2019Linardon et al, , 2017aLinardon et al, , 2017bLinardon et al, , 2017cLoucas et al, 2014;…”

Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses

“…1. Out of 884 articles, 55 MAs and 4 NMAs were included (Albano et al, 2019;Bacaltchuk et al, 1999;Josue Josué Bacaltchuk et al, 2000;Josue Bacaltchuk et al, 2000;Josué Josue Bacaltchuk et al, 2000;Josué Bacaltchuk et al, 2000;Bacaltchuk and Hay, 2003;Barakat et al, 2019;Berkman et al, 2015;Brownley et al, 2016;Cassioli et al, 2020;Claudino et al, 2006;Couturier et al, 2013;Cuijpers et al, 2016;de Vos et al, 2014;Dold et al, 2015;Fisher et al, 2018Fisher et al, , 2010Fornaro et al, 2016;Ghaderi et al, 2018;Ghaderi and Andersson, 1999;Grenon et al, 2018a;Hagan et al, 2020;Hasselbalch et al, 2020;Hay et al, 2019Hay et al, , 2015Hay et al, , 2004Hay et al, , 2001Hay et al, , 2009Hilbert et al, 2019;Kishi et al, 2012;Lebow et al, 2013;Linardon, 2018b;Linardon et al, 2020Linardon et al, , 2019Linardon et al, , 2017aLinardon et al, , 2017bLinardon et al, , 2017cLoucas et al, 2014;…”

Efficacy of sertraline for bulimia nervosa

“…The first limitation was the uncontrolled open trial design. As eating disorder patients have been shown to respond to placebo treatment (Bacaltchuk et al, 1999), we cannot exclude the possibility that the positive response to treatment was specifically in response to the sertraline treatment. Therefore, it will be important to examine the efficacy of sertraline in a double-blind, placebo-controlled trial that includes a larger sample size than that examined in the current study.…”

Bulimia nervosa

“…The second systematic review found significantly higher withdrawal rates in people taking antidepressants than with placebo (12 RCTs, 10.5% v 5.1%) 29. It found no significant difference in withdrawal rates due to adverse effects among and within classes of antidepressants.…”

“…We found two systematic reviews, 21 29 two additional RCTs, 30 31 and two subsequent RCTs. 32 33 Versus placebo: Both reviews found that antidepressants reduced bulimic symptoms.…”

“…The review found no significant difference in effect between different classes of antidepressants, but there were too few trials to exclude a clinically important difference (table 2). Fluoxetine was the only selective serotonin reuptake inhibitor included in the review, and only one trial reported remission rates 29. Two additional RCTs (not in either of the above reviews) found that significantly more improvement was maintained after withdrawal of antidepressant treatment that had been continued for six months 34.…”

Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses

“…1. Out of 884 articles, 55 MAs and 4 NMAs were included (Albano et al, 2019;Bacaltchuk et al, 1999;Josue Josué Bacaltchuk et al, 2000;Josue Bacaltchuk et al, 2000;Josué Josue Bacaltchuk et al, 2000;Josué Bacaltchuk et al, 2000;Bacaltchuk and Hay, 2003;Barakat et al, 2019;Berkman et al, 2015;Brownley et al, 2016;Cassioli et al, 2020;Claudino et al, 2006;Couturier et al, 2013;Cuijpers et al, 2016;de Vos et al, 2014;Dold et al, 2015;Fisher et al, 2018Fisher et al, , 2010Fornaro et al, 2016;Ghaderi et al, 2018;Ghaderi and Andersson, 1999;Grenon et al, 2018a;Hagan et al, 2020;Hasselbalch et al, 2020;Hay et al, 2019Hay et al, , 2015Hay et al, , 2004Hay et al, , 2001Hay et al, , 2009Hilbert et al, 2019;Kishi et al, 2012;Lebow et al, 2013;Linardon, 2018b;Linardon et al, 2020Linardon et al, , 2019Linardon et al, , 2017aLinardon et al, , 2017bLinardon et al, , 2017cLoucas et al, 2014;…”

Efficacy of sertraline for bulimia nervosa

“…The first limitation was the uncontrolled open trial design. As eating disorder patients have been shown to respond to placebo treatment (Bacaltchuk et al, 1999), we cannot exclude the possibility that the positive response to treatment was specifically in response to the sertraline treatment. Therefore, it will be important to examine the efficacy of sertraline in a double-blind, placebo-controlled trial that includes a larger sample size than that examined in the current study.…”

Bulimia nervosa

“…The second systematic review found significantly higher withdrawal rates in people taking antidepressants than with placebo (12 RCTs, 10.5% v 5.1%) 29. It found no significant difference in withdrawal rates due to adverse effects among and within classes of antidepressants.…”

“…We found two systematic reviews, 21 29 two additional RCTs, 30 31 and two subsequent RCTs. 32 33 Versus placebo: Both reviews found that antidepressants reduced bulimic symptoms.…”

“…The review found no significant difference in effect between different classes of antidepressants, but there were too few trials to exclude a clinically important difference (table 2). Fluoxetine was the only selective serotonin reuptake inhibitor included in the review, and only one trial reported remission rates 29. Two additional RCTs (not in either of the above reviews) found that significantly more improvement was maintained after withdrawal of antidepressant treatment that had been continued for six months 34.…”

Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses

“…1. Out of 884 articles, 55 MAs and 4 NMAs were included (Albano et al, 2019;Bacaltchuk et al, 1999;Josue Josué Bacaltchuk et al, 2000;Josue Bacaltchuk et al, 2000;Josué Josue Bacaltchuk et al, 2000;Josué Bacaltchuk et al, 2000;Bacaltchuk and Hay, 2003;Barakat et al, 2019;Berkman et al, 2015;Brownley et al, 2016;Cassioli et al, 2020;Claudino et al, 2006;Couturier et al, 2013;Cuijpers et al, 2016;de Vos et al, 2014;Dold et al, 2015;Fisher et al, 2018Fisher et al, , 2010Fornaro et al, 2016;Ghaderi et al, 2018;Ghaderi and Andersson, 1999;Grenon et al, 2018a;Hagan et al, 2020;Hasselbalch et al, 2020;Hay et al, 2019Hay et al, , 2015Hay et al, , 2004Hay et al, , 2001Hay et al, , 2009Hilbert et al, 2019;Kishi et al, 2012;Lebow et al, 2013;Linardon, 2018b;Linardon et al, 2020Linardon et al, , 2019Linardon et al, , 2017aLinardon et al, , 2017bLinardon et al, , 2017cLoucas et al, 2014;…”

Efficacy of sertraline for bulimia nervosa

“…The first limitation was the uncontrolled open trial design. As eating disorder patients have been shown to respond to placebo treatment (Bacaltchuk et al, 1999), we cannot exclude the possibility that the positive response to treatment was specifically in response to the sertraline treatment. Therefore, it will be important to examine the efficacy of sertraline in a double-blind, placebo-controlled trial that includes a larger sample size than that examined in the current study.…”

Bulimia nervosa

“…The second systematic review found significantly higher withdrawal rates in people taking antidepressants than with placebo (12 RCTs, 10.5% v 5.1%) 29. It found no significant difference in withdrawal rates due to adverse effects among and within classes of antidepressants.…”

“…We found two systematic reviews, 21 29 two additional RCTs, 30 31 and two subsequent RCTs. 32 33 Versus placebo: Both reviews found that antidepressants reduced bulimic symptoms.…”

“…The review found no significant difference in effect between different classes of antidepressants, but there were too few trials to exclude a clinically important difference (table 2). Fluoxetine was the only selective serotonin reuptake inhibitor included in the review, and only one trial reported remission rates 29. Two additional RCTs (not in either of the above reviews) found that significantly more improvement was maintained after withdrawal of antidepressant treatment that had been continued for six months 34.…”