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Treatments for Bulimia Nervosa

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.


The two main categories of treatment available for Bulimia Nervosa are psychotherapy and medications. The question of whether to combine, at the outset, psychotherapy with medications in the treatment of Bulimia Nervosa remains inconclusive, with some studies suggesting that combination treatment is superior [ref, ref], and other studies arguing against this [ref, ref]. However, there is some evidence that psychotherapy alone is superior to medications alone for treating this condition [ref, ref]. Therefore, in the absence of more conclusive data, a reasonable option for most individuals with Bulimia Nervosa would be to start with psychotherapy and then, after several weeks, to add medications if necessary [ref].

Psychotherapy for Bulimia Nervosa

Cognitive Behavioral Therapy (CBT) is perhaps the most commonly used psychotherapy for treating Bulimia Nervosa, and it has the greatest amount of empirical evidence to support its use [ref]. For that reason, it should be considered as the first-line treatment. Other individual therapies that can be used include Interpersonal Therapy and Psychodynamic Therapy [ref].

For children and adolescents with Bulimia Nervosa, Family Therapy can be an effective treatment [ref].

Group Therapy also seems to be an effective treatment [ref, ref], especially if it includes dietary counselling and management as part of the program [ref]. Many treatment programs will offer a combination of individual and group therapy, though there is no available data to know whether the combination is superior to using either modality alone.

Medications for Bulimia Nervosa

Antidepressants are the main group of medications used for treating Bulimia Nervosa, and overall they seem to be effective [ref]. Fluoxetine would be the first choice medication because of its decent side-effect profile and the available supporting evidence. Using high doses of this medication (60mg/day) seems to give better results [ref]. Trying other SSRIs would be the next recommendation [ref]. If successful, these medications should be continued for at least a year after the condition has resolved in order to help prevent a relapse [ref].

Topiramate has also shown to be effective for diminishing the symptoms of Bulimia Nervosa [ref].

Tricyclic Antidepressants, MAOIs and Bupropion have all been found to be effective for treating Bulimia Nervosa, but because of possible dangerous side-effects that could occur if using these medications while one is binge-eating and purging, they are not recommended for routine use [ref].


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