Antidepressant medicines for bulimia nervosa

Antidepressant medicines reduce binge eating and purging in up to 75% of people who have bulimia nervosa.1 Antidepressants that are most commonly used to reduce the binge-purge cycle associated with bulimia are:

  • Fluoxetine (such as Prozac), which is a selective serotonin reuptake inhibitor (SSRI). Other SSRIs have not yet been proven to be effective for bulimia.
  • Tricyclics, such as imipramine (Tofranil, for example), amitriptyline, and desipramine (Norpramin, for example).

Antidepressants regulate brain chemicals that control mood. Guilt, anxiety, and depression about binging usually lead to purging. Antidepressants help keep emotions stable and can help reduce the frequency of binge-purge cycles.2

Antidepressants may produce some side effects. But side effects may be reduced or may go away after several weeks of treatment.

Before starting an antidepressant, tell your doctor about every medicine or supplement (prescription or nonprescription) that you are taking. Some antidepressants can have serious interactions with other medicines or dietary supplements.

Fluoxetine

Fluoxetine (such as Prozac) reduces binge-purge cycles in bulimia.3

Studies show that the side effects of fluoxetine bother people less than the side effects of other antidepressants, such as tricyclics.4 This medicine also has a low risk of overdose, and it does not require diet changes. Although side effects of fluoxetine are usually mild, they can include nausea, loss of appetite, diarrhea, anxiety, irritability, problems sleeping or drowsiness, loss of sexual desire or ability, headaches, dizziness, and dry mouth.

Tricyclic antidepressants

Tricyclic side effects can include stomach upset, constipation, dry mouth, blurred vision, and drowsiness. Some people gain weight and have problems with sexual desire and ability. Tricyclics are started in low doses and gradually increased to avoid overdose and other serious side effects.

FDA Advisory

The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

What to think about

You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.

Antidepressants work best when combined with psychological counseling for the treatment of bulimia.5

Studies have found daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Talk to your doctor about this risk before taking an SSRI.

SSRIs make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.6

People who purge after they take antidepressants may not get enough of the medicine into their blood. Health professionals may recommend that they take antidepressant medicine at bedtime after they have stopped purging. People who purge often need to have their blood checked regularly to measure the amount of medicine in their bloodstream.

Citations

  1. Steering Committee on Practice Guidelines, American Psychiatric Association (2006). Treating Eating Disorders: A Quick Reference Guide. Arlington, VA: American Psychiatric Publishing.
  2. Halmi KA (2008). Eating disorders: Anorexia nervosa, bulimia nervosa, and obesity. In RE Hales et al., eds., Textbook of Clinical Psychiatry, 5th ed., pp. 971–977. Washington, DC: American Psychiatric Publishing.
  3. Hay P, Bacaltchuk J (2008). Bulimia nervosa, search date June 2007. Online version of Clinical Evidence: www.clinicalevidence.com.
  4. Bacaltchuk J, Hay P (2007). Antidepressants versus placebo for people with bulimia nervosa. Cochrane Database of Systematic Reviews (2).
  5. Bacaltchuk J, et al. (2001). Antidepressants versus psychological treatments and their combination for bulimia nervosa. Cochrane Database of Systematic Reviews (4).
  6. Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795–803.

Last Updated: September 16, 2009

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