CPG for Eating Disorders

An RCT (Appolinario, 2003; Brazil) 307 compared sibutramine vs. placebo in outpatientswith BED (88% women; mean age 35.2 to 36.6). Sibutramine is associated withdecreased depressive behaviour and is superior to placebo in reducing the frequency andseverity of binge-eating episodes. In the placebo group weight gain was observed duringand by the end of treatment. In the group treated with the drug, weight loss by the end oftreatment was reported.RCT1++Summary of the EvidenceSRSE 311++SRSE 311++In short-term RCTs with SSRI antidepressants, the group treated with thesedrugs presents better results in the reduction of symptoms related with eatingdisorders, in behaviour, weight and severity of the disease. The clinical impactof these conclusions cannot be judged due to the lack of data on total BEDremission and on follow-up.Low doses of imipramine as a complementary strategy to nutritionalcounselling and psychological therapy are associated with reduced binge-eatingand weight loss that is sustained after drug discontinuation.Recommendations(See also recommendation 9.GPH.6.)B 9.9.3.1.1. SSRI antidepressant treatment can be offered to a patient with BED,regardless of whether he/she follows a guided SH programme or not.(Adopted from recommendation 8.3.5.1. of the NICE guide).B 9.9.3.1.2. Patients must be informed that SSRI antidepressant treatment can reducethe frequency of binge-eating, but the duration of long-term effects isunknown. Antidepressant treatment may be beneficial for a small numberof patients. (Adopted from recommendation 8.3.5.2. of the NICE guide).9.9.3.2. What is the safety of antidepressants in patients with BED?The answer is based on the NICE CPG (2004) 30 , which describes the results of RCTs, onthe high-quality SRSE (1++) elaborated by the AHRQ of the US (2006) 31 and a more recentlypublished one carried out by Brownley, et al. (2007) 245 . The updated search has not identifiedany new evidence. Studies are briefly described in question 9.9.3.1.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS148