Article type
Year
Abstract
Introduction: BN is an eating disorder characterized by uncontrolled compulsive eating binges, followed by recurrent use of inadequate compensatory behaviors in order to prevent weight gain. The prevalence among adolescent and young adult females is approximately 1%-3% (APA 1994). Antidepressants and psychotherapy, mainly cognitive-behavior therapy, are the two most studied treatment approaches for this disorder. This review attempted to systematically evaluate the use of antidepressants compared to psychotherapy for the treatment of BN.
Objective: our primary objective was to compare the efficacy of antidepressants versus psychotherapies in the treatment of adolescent and adult patients with BN. We also intended to examine whether there was any increase in efficacy when both treatments are combined.
Methods: trials were identified through electronic searching, 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). 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. 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 6 trials included in this meta-analysis did not show any statistically significant effect in favor of antidepressants over psychotherapy on any of the efficacy outcomes (remission of bulimic symptoms, clinical improvement, change in bulimic symptoms and depression). Patients on psychotherapy presented a significant lower rate of drop-outs. Combination of both treatments did not change efficacy of either antidepressants or psychotherapy. A significant difference on drop-outs in favor of psychotherapy was observed (OR:2.90[1.51,5.57]).
Discussion: preliminary results did not show any significant difference in the efficacy parameters analysed between the two treatments. Psychotherapy seems to be better accepted then antidepressants. Further studies are necessary to compare the efficacy between these two approaches as well as their combination.
Objective: our primary objective was to compare the efficacy of antidepressants versus psychotherapies in the treatment of adolescent and adult patients with BN. We also intended to examine whether there was any increase in efficacy when both treatments are combined.
Methods: trials were identified through electronic searching, 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). 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. 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 6 trials included in this meta-analysis did not show any statistically significant effect in favor of antidepressants over psychotherapy on any of the efficacy outcomes (remission of bulimic symptoms, clinical improvement, change in bulimic symptoms and depression). Patients on psychotherapy presented a significant lower rate of drop-outs. Combination of both treatments did not change efficacy of either antidepressants or psychotherapy. A significant difference on drop-outs in favor of psychotherapy was observed (OR:2.90[1.51,5.57]).
Discussion: preliminary results did not show any significant difference in the efficacy parameters analysed between the two treatments. Psychotherapy seems to be better accepted then antidepressants. Further studies are necessary to compare the efficacy between these two approaches as well as their combination.