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Early response to antidepressant treatment in bulimia nervosa

Published online by Cambridge University Press:  15 September 2009

R. Sysko ,
N. Sha ,
Y. Wang ,
N. Duan  and
B. T. Walsh
R. Sysko*
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
N. Sha
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
Y. Wang
Affiliation:
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA Division of Biostatistics and Data Coordination, New York State Psychiatric Institute, New York, NY, USA
N. Duan
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA Division of Biostatistics and Data Coordination, New York State Psychiatric Institute, New York, NY, USA
B. T. Walsh
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
*
*Address for correspondence: Dr R. Sysko, Columbia Center for Eating Disorders, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA. (Email: [email protected])
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Abstract

Background

Bulimia nervosa (BN) is a serious psychiatric disorder characterized by frequent episodes of binge eating and inappropriate compensatory behavior. Numerous trials have found that antidepressant medications are efficacious for the treatment of BN. Early response to antidepressant treatment, in the first few weeks after medication is initiated, may provide clinically useful information about an individual's likelihood of ultimately benefitting or not responding to such treatment. The purpose of this study was to examine the relationship between initial and later response to fluoxetine, the only antidepressant medication approved by the US Food and Drug Administration (FDA) for the treatment of BN, with the goal of developing guidelines to aid clinicians in deciding when to alter the course of treatment.

Method

Data from the two largest medication trials conducted in BN (n=785) were used. Receiver operating characteristic (ROC) curves were constructed to assess whether symptom change during the first several weeks of treatment was associated with eventual non-response to fluoxetine at the end of the trial.

Results

Eventual non-responders to fluoxetine could be reliably identified by the third week of treatment.

Conclusions

Patients with BN who fail to report a ⩾60% decrease in the frequency of binge eating or vomiting at week 3 are unlikely to respond to fluoxetine. As no reliable relationships between pretreatment characteristics and eventual response to pharmacotherapy have been identified for BN, early response is one of the only available indicators to guide clinical management.

Keywords

Antidepressant medicationbulimia nervosaearly responsefluoxetine
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 6 , June 2010 , pp. 999 - 1005
Copyright
Copyright © Cambridge University Press 2009

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