Fluoxetine and Fluvoxamine Combined with Individual Cognitive-Behaviour Therapy in Binge Eating Disorder: A One-Year Follow-Up Study

Abstract

Background: The treatment of binge eating disorder (BED) is still the object of debate. In the present study, the effectiveness of antidepressant drugs (fluoxetine – FLX – 60 mg/day, fluvoxamine – FLV –300 mg/day), cognitive-behavioural therapy (CBT) and combined treatments (CBT + FLX, CBT + FLV) has been evaluated in a randomized, clinical trial. Results at the end of the active treatment (in the 24th week) and 1-year follow-up outcomes have been evaluated. Methods: One hundred eight (44 M, 64 F) BED patients were randomly assigned to either CBT, FLX (60 mg/day), FLV (300 mg/day), CBT + FLX or CBT + FLV, for 24 weeks. At the beginning (T0), at the end (T1) of treatment and after 1 year (T2), body mass index (BMI) and eating attitude and behaviours (by EDE 12.0D) were assessed. Results: At T1, BMI and EDE scores were significantly reduced in CBT, CBT + FLX and CBT + FLV, but not in the FLX and FLV treatment groups. In the CBT + FLV group, a greater (p < 0.05) reduction of EDE total scores was observed, when compared to CBT + FLX or CBT treatment groups. At T2, BMI was significantly higher than at T1, but still significantly lower than at T0 in the CBT, CBT + FLX and CBT + FLV groups, while EDE scores remained unchanged from T1 in all treatment groups. Conclusions: CBT was more effective than FLX or FLV in the treatment of BED. The addition of FLX to CBT does not seem to provide any clear advantage, while the addition of FLV could enhance the effects of CBT on eating behaviours. Modifications of eating behaviours are maintained at the 1-year follow-up, although the lost weight was partly regained.

A novel procedure for assessing the effects of drugs on satiation in baboons: effects of memantine and dexfenfluramine

“…Indeed, Stunkard et al (1996) reported than obese patients who reported binge eating decreased the rate of binge eating during a 8-week DFEN treatment trial faster than individuals receiving placebo. Subsequent studies confirmed that medications that increase serotonin levels were effective in decreasing binge eating in obese patients (e.g., Hudson et al 1998;McElroy et al 2000;Ricca et al 2001). A medication that reduced abnormally large meals should be effective for the treatment of obesity.…”

Evidências sobre a terapia cognitivo-comportamental no tratamento de obesos com transtorno da compulsão alimentar periódica

“…Adicionalmente, estudos controlados randomizados também relataram reduções significativas na freqüência da compulsão ao final da TCC 11,12,[24][25][26][27] . Agras et al 24 realizaram um estudo comparativo entre TCC e terapia interpessoal (TI), um formato de terapia que focaliza o aumento da capacidade para lidar com dificuldades interpessoais e com os papéis sociais no tratamento do TCAP 21 .…”

“…Alguns estudos controlados randomizados compararam a eficácia da TCC isoladamente com a TCC associada a fármacos 7,[27][28][29] . Esses estudos demonstraram reduções significativas da compulsão alimentar após a TCC, sem benefício adicional com o uso de desipramina 7 , fluoxetina 27-29 ou fluvoxamina 27 .…”

“…Esses estudos demonstraram reduções significativas da compulsão alimentar após a TCC, sem benefício adicional com o uso de desipramina 7 , fluoxetina 27-29 ou fluvoxamina 27 . Grilo et al 29 randomizaram 108 pacientes para quatro condições: TCC no formato individual combinada com fluoxetina, TCC combinada com placebo, fluoxetina ou placebo.…”

“…Além da compulsão alimentar, alguns ensaios clínicos investigaram outros comportamentos e atitudes disfuncionais associados à alimentação, peso e forma corporais em obesos com TCAP 11,12,[22][23][24][25][26][27]29,30,[33][34][35] . Um dos aspectos estudados é a tentativa (em geral, malsucedida) de restringir a alimentação de forma inadequada para obter emagrecimento.…”