Treatment for Bulimia
Some doctors recommend a stepped approach for patients with bulimia, which follow specific stages depending on the severity and response to initial treatments:
- Support groups may be helpful for patients who have mild conditions with no health consequences.
- Cognitive-behavioral therapy (CBT) along with nutritional therapy is the preferred first treatment for bulimia that does not respond to support groups.
- Drug therapy used for bulimia is typically a selective serotonin-reuptake inhibitor (SSRI) antidepressant. A combination of CBT and SSRIs may be effective if CBT alone is not helpful.
Patients with bulimia rarely need hospitalization except under the following circumstances:
- Binge-purge cycles have led to anorexia
- Drugs are needed for withdrawal from purging
- Major depression is present
Psychotherapeutic Approaches and Medications for Bulimia
Psychologic Therapy. Cognitive-behavioral therapy (CBT) is the first-line of therapy for most patients with bulimia. Interpersonal therapy may be tried if CBT fails. In interpersonal therapy (also known as "talk therapy"), therapists help patients explore how social and family relationships may affect their eating disorder.
Antidepressants. The most common antidepressants prescribed for bulimia are selective serotonin reuptake inhibitors (SSRIs) such as:
- Fluoxetine (Prozac, generic)
- Sertraline (Zoloft, generic)
- Paroxetine (Paxil, generic)
- Fluvoxamine (Luvox, generic)
Studies are mixed, however, on whether SSRIs offer an additional advantage in reducing binge-eating compared to CBT. Fluoxetine has been approved for bulimia and is considered the drug of choice, although some studies suggest that other SSRIs work just as well. Other types of antidepressants, such as tricyclics, MAO inhibitors, and buprorion (Wellbutrin, generic), carry more risks of side effects than SSRIs and do not appear to be effective for treatment of bulimia.
Antidepressants may increase the risks for suicidal thoughts and actions during the first few months of treatment. In particular, adolescents and young adults should be carefully monitored during this time period for any changes in behavior. [For more information on antidepressants, see In-Depth Report #08: Depression.]
Other Drug Therapy for Bulimia Nervosa
Topiramate. The antiepileptic drug topiramate (Topamax, generic) has been shown in studies to reduce bingeing and purging episodes in patients with bulimia. However, due to this drug’s risk for serious side effects, topiramate should be used only if other medication has failed. In addition, because people tend to lose weight while taking topiramate, it should not be used by patients who have low or even normal body weight.
Review Date: 02/18/2011
Reviewed By: David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital; and David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.