CPG for Eating Disorders

Antidepressants vs. antidepressants-psychological therapyVariables: reduction / remission of binge-eating and purgingThere is insufficient evidence to show that antidepressants (desipramine, fluoxetine,imipramine) differ from the combination of CBT-antidepressants with regard to remissionof binge eating episodes (5 RCTs; N=291; Leitenberg, 1994 321 ; Jacobi, 2002 322 ;Goldbloom, 1997 323 ; Agras, 1992 324 ; Walsh, 1997 233 ; randomised effects model RR: 1.29;95% CI: 0.99 to 1.69) and remission of purging episodes (5 RCTs; N=199; Leitenberg,1994 321 ; Jacobi, 2002 322 ; Goldbloom, 1997 323 ; Agras, 1992 324 ; Walsh, 1997 233 ; randomisedeffects model RR: 1.23; 95% CI: 0.93 to 1.64) at treatment completion.There is strong evidence to determine that the combination antidepressants-CBT vs.antidepressants (desipramine, fluoxetine) is suitable to reduce the frequency of bingeeatingepisodes (4 RCTs; N=133; Jacobi, 2002 322 ; Goldbloom, 1997 323 ; Agras, 1992 324 ;Walsh, 1997 233 ; SMD: 0.55; 95% CI: 0.21 to 0.90) but limited to reduce the frequency ofpurging episodes at treatment completion (5 RCTs; N=141; Leitengerg, 1994 321 ; Jacobi,2002 322 ; Goldbloom, 1997 323 ; Agras, 1992 324 ; Walsh, 1997 233 ; SMD: 0.49; 95% CI: 0.15 to0.83).There is insufficient evidence to show that antidepressants (desipramine, fluoxetine)differ from the combination of CBT-antidepressants with regard to remission andfrequency of binge eating episodes (2 RCTs; N=81; Jacobi, 2002 322 ; Agras, 1992 324 ; RR:1.12; 95% CI: 0.88 to 1.42), (1 RCT; N=21; Agras, 1992 324 ; SMD: 0,29; 95% CI: -0.58 to1.15), respectively, and in the remission and frequency of purging episodes (3 RCTs;N=95; Leitenberg, 1994 321 ; Jacobi, 2002 322 ; Agras, 1992 324 ; RR: 1.10; 95% CI: 0.87 to1.39), (2 RCTs; N=29; Leitenberg, 1994 321 ; Agras, 1992 324 ; SMD: 0.46; 95% CI: -0.31 to1.23) at post-treatment follow up, respectively.There is insufficient evidence to show that antidepressants (fluoxetine) differ from thecombination of SH-antidepressants with regard to remission and frequency of bingeeatingepisodes (1 RCT; N=47; Mitchell, 2001 258 ; RR: 1.11; 95% CI:0.83 to 1.48), (1RCT; N=34; Mitchell, 2001 258 ; SMD: 0.37; 95% CI: -0.24 to 0.97) and remission andfrequency of purging episodes (1 RCT; N=47; Mitchell, 2001 258 ; RR:1.11; 95% CI: 0.83to 1.48), (1 RCT; N=34; Mitchell, 2001 258 ; SMD: 0.31; 95% CI:-0.29 to 0.91)respectively, at treatment completion.There is insufficient evidence to show that antidepressants (desipramine) differ from thecombination de SFP-antidepressants with regard to remission and frequency of bingeeating episodes (RR: 0.95; 95% CI: 0.75 to 1.21), (SMD: -0,29; CI 95%: -0.85 to 0.27)and remission and frequency of purging episodes (RR: 0.95; 95% CI:0.75 to 1.21 andSMD: 0.26; 95% CI: -0.30 to 0.83) respectively at treatment completion according to 1RCT (N=50; Walsh, 1987) 288 .Variable: depressionThere is insufficient evidence to show that the combination of CBT-antidepressantsRCT1++RCT1++RCT1++RCT1++RCT1++RCT1++162CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS