CPG for Eating Disorders

SRSE 311++SRSE 311++Due to the small-sized samples of both RCTs (Kaye, 2001 279 and Attia, 1998 280 )that use fluoxetine, no conclusions can be drawn regarding whether harmfuleffects associated with treatment in low-weight individuals differ from theharmful effects in normal weight individuals or those with psychiatricdisorders.In an RCT (Kaye, 2001) 279 , no adverse effects were reported in the fluoxetinegroup. In another RCT (Attia, 1998) 280 , one case of insomnia and agitation andone case of blurred vision were reported in the fluoxetine group. In regard totricyclic antidepressants, another RCT (Halmi, 1986) 282 with amitriptylinereported sporadic cases of associated drowsiness, excitement, confusion,increased motor activity, tachycardia, dry mouth and constipation; however, theproportion of adverse effects was similar between the experimental group andthe control group (placebo).Recommendations(See recommendations 9.GPH.1 to 9.GPH.6)9.9.2. Bulimia nervosa9.9.2.1. What is the efficacy of antidepressants in patients with BN?The answer is based on the NICE CPG (2004) 30 , which describes the RCT results basedon variables of interest, on the SRSE of sufficient quality (1++) elaborated by the AHRQ of theUS (2006) 31 and on a more recently published one by Shapiro, et al. (2007) 211 . The updated searchhas not identified any new evidence.Variable: BMIThere is not sufficient evidence to indicate clinically significant differences between SSRIantidepressants (fluoxetine) and placebo in relation to body weight by the end of treatment (1RCT; N=46; Kanerva, 1994 285 ; SMD: -0.30; 95% CI: -0.88 to 0.28).Variables: reduction / remission of binge-eating and purgingThere is limited evidence to determine that antidepressant treatment (fluoxetine,desipramine, phenelzine [withdrawn from the Spanish market], trazodone, bupropion) issuperior to placebo in the remission of binge-eating and purging by the end of treatment(6 RCTs; N=697; McCann, 1990262; Walsh, 1991286; Goldstein, 1995287; Walsh,1987288; Horne, 1988289; Pope, 1989290; RR: 0.88; 95% CI: 0.83 to 0.94; NNT: 9;95% CI: 6 to 15).RCT1++141CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS