Article type
Year
Abstract
Introduction: BN is an eating disorder characterized by uncontrolled compulsive eating binges, followed by recurrent use of self-induced purging as vomiting, laxative abuse, or other inappropriate compensatory methods to prevent weight gain. The prevalence among adolescent and young adult females is approximately 1%-3% (APA 1994). This review attempted to systematically evaluate the use of antidepressants compared to placebo for the treatment of BN.
Objectives: the primary objective of this review was to determine whether antidepressants were clinically effective for the treatment of bulimia nervosa. We also intended to examine whether there was a differential effect for the various classes/types of antidepressants regarding their effectiveness and tolerability.
Methods: trials were identified through eletronic screening, handsearching of references, pharmaceutical companies and personal contact with investigators. The methodological quality of the trials was assessed using the criteria described in the Cochrane Handbook (Mulrow 1997) and the Jadad Scale (Jadad 1996). Dichotomous outcomes were analysed by calculating Peto odds ratios (OR) and 95% confidence intervals for each trial. The odds ratios from the individual trials were combined using appropriate methods of meta-analysis. For continuous outcomes the mean and standard deviation of these measures were assessed (Weighted mean difference [WMR]). Trials were included if they met quality assessment criteria A or B according to the Handbook. A cut-off of two points was used in the Jadad scale to check the assessment made by the Handbook criteria. Heterogeneity in the results of the trials was assessed both by inspection of graphical presentations and by calculating a test of heterogeneity using a X2 statistic.
Results: preliminary analysis of 20 trials included in this meta-analysis showed a statistically significant effect in favor of antidepressants over placebo on the following outcomes: a) remission of bulimic symptoms (OR:0.54[0.36,0.82]); b) clinical improvement (OR:0.35[0.26,0.47]); c) difference in bulimic symptoms (WMD:-2.678[-3.865,-1.491]); and a significant difference on drop-outs due to adverse effects in favor of placebo (OR:2.11[1.35,3.32]).
Discussion: antidepressants appear to be effective compared to placebo for the treatment of BN.
Objectives: the primary objective of this review was to determine whether antidepressants were clinically effective for the treatment of bulimia nervosa. We also intended to examine whether there was a differential effect for the various classes/types of antidepressants regarding their effectiveness and tolerability.
Methods: trials were identified through eletronic screening, handsearching of references, pharmaceutical companies and personal contact with investigators. The methodological quality of the trials was assessed using the criteria described in the Cochrane Handbook (Mulrow 1997) and the Jadad Scale (Jadad 1996). Dichotomous outcomes were analysed by calculating Peto odds ratios (OR) and 95% confidence intervals for each trial. The odds ratios from the individual trials were combined using appropriate methods of meta-analysis. For continuous outcomes the mean and standard deviation of these measures were assessed (Weighted mean difference [WMR]). Trials were included if they met quality assessment criteria A or B according to the Handbook. A cut-off of two points was used in the Jadad scale to check the assessment made by the Handbook criteria. Heterogeneity in the results of the trials was assessed both by inspection of graphical presentations and by calculating a test of heterogeneity using a X2 statistic.
Results: preliminary analysis of 20 trials included in this meta-analysis showed a statistically significant effect in favor of antidepressants over placebo on the following outcomes: a) remission of bulimic symptoms (OR:0.54[0.36,0.82]); b) clinical improvement (OR:0.35[0.26,0.47]); c) difference in bulimic symptoms (WMD:-2.678[-3.865,-1.491]); and a significant difference on drop-outs due to adverse effects in favor of placebo (OR:2.11[1.35,3.32]).
Discussion: antidepressants appear to be effective compared to placebo for the treatment of BN.