CPG for Eating Disorders

There is insufficient evidence suggesting that there are significant differences betweentricyclic antidepressants (imipramine, desipramine) and placebo in the number ofpatients who discontinue treatment due to adverse effects (3 RCTs; N=187; Pope,1983 293 ; Mitchell, 1990 243 ; Walsh, 1991 286 ; RR: 3.17; 95% CI: 0.84 to 11.90).There is insufficient evidence to determine that there is a significant difference betweenMAOI antidepressants (phenelzide [withdrawn from the Spanish market] andmoclobemide) and placebo in the number of patients who discontinue treatment due toadverse effects (random effects model RR: 2.55; 95% CI: 0.20 to 33.22) or any otherreason (random effects model RR: 0.94; 95% CI: 0.50 to 1.77; based on 2 RCTs;N=139; Walsh, 1987 288 ; Carruba, 2001 291 ).In an RCT (Beumont, 1997) 294 fluoxetine was compared with placebo. Adverse effects inthe fluoxetine group included: insomnia, nausea and instability, the latter beingsignificantly more common. Depression was the most common adverse effect in theplacebo group. No dropouts were reported.In an RCT (Fichter, 1991) 295 , that compared fluoxetine vs. placebo, the experimentalgroup showed greater tremor (significant differences). No dropouts were reported.In an RCT (Romano, 2002) 296 fluoxetine was compared with placebo. This studyexplored the efficacy of fluoxetine (60mg/day) in the number of relapses over 52 weeks.Relapses were less frequent in the placebo group (33% vs. 51% in the fluoxetine group).Treatment discontinuation occurred more frequently within the first 3 months of the 52weeks of complete treatment. The same study reported a dropout rate of 83% in thefluoxetine group and 92% in the placebo group. Rhinitis was reported to be the adverseeffect. (fluoxetine, 24 cases; placebo, 12 cases; p