The Efficacy of Duloxetine in the Treatment of Bulimia Nervosa: Case Reports.

Bulimia Nervosa (BN) is one of the most common eating disorders in industrialized societies, characterized by uncontrolled binge eating and self-induced purging or other compensatory behaviours aiming to prevent body weight gain. It has been suggested that reduced serotonergic tone triggers some of the cognitive and mood disturbances associated with BN. In fact, in the active phase of BN the concentration of serotonin in cerebral fluid is reduced. For these reasons, the pharmacologic treatment of BN consists mainly of selective serotonin reuptake inhibitors (SSRIs). The physiological basis of this disorder is not yet completely understood. Recently, it has been reported that BN may be controlled also by using drugs involving the noradrenaline (NA) system thus suggesting a possible treatment of BN with tricyclic antidepressants or serotonin and noradrenaline reuptake inhibitors (SNRIs). Given the above evidences, it is reasonable to assume the use of duloxetine, a SNRI, in the treatment of BN. This paper presents a series of five clinical cases of patients suffering from BN Purging Type, with comorbid mood depression, treated with duloxetine at a dose of 60 mg/day. Five patients, all women aged between 24 and 35 years, were followed on an outpatient basis for a period of 16 weeks. At the beginning and at the end of the observation period, patients were weighed, BMI was calculated and assessed by the Hamilton Scale for Depression. Assessment of major cardiac and blood chemistry data were done as well. During the observation period, all patients maintained an accurate diary about their binge and self-induced vomiting. At the end of the observation period duloxetine treatment led to a 56% reduction of binge crisis, 63% of compensatory behavior and a reduction of 3.1% of body weight. HAM-D values decreased on an average from 21.6 to 10.2. Duloxetine was significantly effective in reducing binge crisis and the purging behavior possibly by inducing a positive effect on this comorbid depressive symptoms, without significant adverse events. However, these data need to be confirmed by RCT trial on a larger scale.