A Comparative Study between Three Different SSRIs in the Treatment of Bulimia Nervosa

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). At present, the physiologic basis of this disorder is not yet completely understood. In this study we have conducted a randomized controlled trial to compare the efficacy of three different SSRIs, fluoxetine, fluvoxamine, sertraline, in patients with a diagnosis of BN. Sixty female outpatients aged 18 to 34 years with a diagnosis of BN-binge purging (as defined by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM IV]) were randomly assigned to 3 group of treatment: the fluoxetine 60 mg/die group; the fluvoxamine 200 mg/die group and the sertraline 100 mg/die group. The patients underwent weekly clinical assessments for 10 weeks. At the end of treatment, there was a statistically significant reduction in the numbers of bulimic and purging episodes more in the fluoxetine and fluvoxamine group than the sertraline group. In no case was the treatment interrupted for emergent side effects. These findings support the hypothesis that the SSRIs are well tolerated and effectively reduce the bulimic crisis and purging episodes in patients with BN.