Medical Health Encyclopedia

Antidepressants. Because of the high incidence of depression in patients with bulimia, antidepressant medication is often recommended for patients who have normal weight or for those who are overweight. They should be used in combination with CBT. (These drugs can cause weight loss and should not be used in patients who are underweight, unless it is part of a clinical trial.)

The most common antidepressants prescribed for bulimia are selective serotonin reuptake inhibitors (SSRIs).

They include:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluvoxamine (Luvox)

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Studies are mixed, however, on whether SSRIs offer an additional advantage in reducing binge-eating compared to CBT. Prozac has been approved for bulimia and is considered the drug of choice, although some studies suggest that other SSRIs, such as Luvox, may be even more effective. 

Important note: Recent studies indicate that the use of Prozac and other antidepressants may cause children and teenagers to have suicidal thoughts. Children who are taking these drugs must be monitored very carefully for signs of potential suicidal behavior.

If the drugs are not effective, the doctor should be sure it is not because the patient is vomiting after taking the medication. Some experts believe that these drugs should be continued even after symptoms have improved in order to restore healthy brain chemical balances.

Drug Therapy for Bulimia Nervosa

Drugs to Prevent Vomiting. In one study, ondansetron (Zofran), a drug that prevents vomiting, reduced the binge-purge episodes by half. The drug may cause depression in people already on SSRI antidepressants. More studies are needed.

Sibutramine. Sibutramine (Meridia) is a drug used for weight loss. It does so by keeping two important brain chemicals, serotonin and norepinephrine, in balance, which helps to increase metabolism. Some evidence suggests that the actions of this drug may be useful for people who binge. Note, however, that for bulimic patients this drug should be used only for those with normal or above normal weight and never for those who are anorexic.