CPG for Eating Disorders

There is strong evidence that antidepressant treatment (fluoxetine, desipramine,phenelzine [withdrawn from the Spanish market], trazodone, bupropion) is superior toplacebo in clinical improvement (defined as reducing binge-eating by at least 50%) (6RCTs; N=855; Mc Cann, 1990 262 ; Walsh, 1991 286 ; Goldstein, 1995 287 ; Walsh, 1987 288 ;Horne, 1988 289 ; Pope, 1989 290 ; RR: 0.68; 95% CI:0.60 to 0.78; NNT: 5; 95% CI: 4 to 8).There is insufficient evidence to determine if there is a clinically significant differencebetween antidepressants (fluoxetine, desipramine, phenelzine [withdrawn from theSpanish market], trazodone, bupropion) and placebo in reducing the frequency of bingeeating(6 RCTs; N=290; McCann, 1990 262 ; Walsh, 1991 286 ; Walsh, 1987 288 ; Pope, 1989 290 ;Mitchell, 2001 258 ; Carruba, 2001 291 ; random effects model SMD: -0.33; 95% CI: -1.13 to0.47) and purging by the end of treatment (3 RCTs; N=198; Walsh, 1991 286 ; Pope1989 290 ; Mitchell, 2001 258 ; SMD: -0.19; 95% CI: -0.66 to 0.28).There is limited evidence to determine that MAOI treatment (phenelzine, [withdrawnfrom the Spanish market]) is superior to placebo in the remission of binge-eating andpurging by the end of treatment (1 RCT; N=62; Walsh, 1987 288 ; RR: 0.77; 95% CI: 0.62to 0.95; NNT: 5; 95% CI: 3 to 17).There is insufficient evidence to determine if there is a clinically significant differencebetween SSRI antidepressants (fluoxetine) and placebo in reducing the frequency ofbinge-eating (SMD: -0.30; 95% CI: -0.91 to 0.31) and purging (SMD: -0.56; 95% CI: -1.17 to 0.06) by the end of treatment according to 1 RCT (N=43; Kanerva, 2001) 285 .There is insufficient evidence to determine if there is a clinically significant differencebetween tricyclic antidepressants (desipramine) and placebo in reducing the frequency ofpurging (1 RCT; N=78; Walsh, 1991 286 ; SMD: -0.34; 95% CI: -0.79 to 0.11) by the endof treatment.There is strong evidence to determine that SSRI antidepressant treatment (fluoxetine) issuperior to placebo in reducing binge-eating (3 RCTs; N= 706; Goldstein, 1995 287 ;Kanerva, 1994 285 , Fluoxetine Bulimia Nervosa Collaborative Study Group, 1992 292 ; RR:0.73; 95% CI: 0.62 to 0.84; NNT: 6; 95% CI: 5 to 12) and purging by at least 50% by theend of treatment (2 RCTs; N=656; Goldstein, 1995 287 , Fluoxetine Bulimia NervosaCollaborative Study Group, 1992 292 ; RR: 0.66; 95% CI: 0.57 to 0.76; NNT: 5; 95% CI: 4to 7).There is strong evidence to determine that tricyclic antidepressant treatment(imipramine) is superior to placebo in terms of clinical improvement (defined asreducing binge-eating by at least 50%) by the end of treatment (1 RCT; N=22; Pope,1983 293 ; RR: 0.30; 95% CI: 0.11 to 0.80; NNT: 2; 95% CI: 2 to 4).There is strong evidence to determine that tricyclic antidepressants (imipramine,desipramine) vs. placebo decrease the frequency of binge-eating by the end of treatment(3 RCTs; N=120; Pope, 1983 293 ; McCann, 1990 262 ; Walsh, 1991 286 ; SMD:-0.82; 95% CI: -1.20 to -0.45).RCT1++RCT1++RCT1++RCT1++RCT1++RCT1++RCT1++RCT1++142CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS