Eating Disorders - Treatment for Bulimia

Highlights	Complications of Anorexia	Treatment for Anorexia
Introduction	Symptoms	Therapy
Risk Factors	Diagnosis	Resources
Causes	Treatment	References
Complications of Bulimia	Treatment for Bulimia

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Treatment for Bulimia

Some experts recommend a stepped approach for patients with bulimia, which may follow these stages, depending on the severity and response to initial treatments:

Support groups. This is the least expensive approach and 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.
Drugs. The drugs used for bulimia are typically antidepressants known as selective serotonin-reuptake inhibitors (SSRIs). A combination of CBT and SSRIs is very effective if CBT 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 and is successful in about 60% of cases. In one study of bulimic patients those who did not respond to CBT tended to be less committed to the treatment, were more preoccupied with their symptoms, and had ritualized eating behaviors. Interpersonal therapy may be tried if CBT fails, although in one study it was no more successful than antidepressants. Some studies have found that bulimic patients respond well to self-help CBT with a CD-ROM or manual. These methods, the research found, reduced the incidence of both binging and vomiting.

Antidepressants. Because of the high incidence of depression in patients with bulimia, antidepressant medication is often recommended for patients who have normal weight or for those who are overweight. They should be used in combination with CBT. (These drugs can cause weight loss and should not be used in patients who are underweight, unless it is part of a clinical trial.)

The most common antidepressants prescribed for bulimia are selective serotonin reuptake inhibitors (SSRIs).

They include:

Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluvoxamine (Luvox)

Studies are mixed, however, on whether SSRIs offer an additional advantage in reducing binge-eating compared to CBT. Prozac has been approved for bulimia and is considered the drug of choice, although some studies suggest that other SSRIs, such as Luvox, may be even more effective.