CPG for Eating Disorders

There is insufficient evidence to determine if there is a clinically significant differencebetween the treatment with CBT and the combination of CBT-antidepressants(imipramine) in the number of withdrawals due to adverse effects (1 RCT; N=86;Mitchell, 1990 243 ; RR: 0.51; 95% CI: 0.06 to 4.70).There is insufficient evidence to determine if there is a clinically significant difference inthe treatment with antidepressants (fluoxetine) vs. fluoxetine-SH regarding the numberof withdrawals for any given reason at treatment completion (2 RCTs; N=91; Mitchell,2001 258 ; Walsh 2004 328 ; RR: 1.15; 95% CI: 0.72 to 1.84).There is insufficient evidence to determine whether treatment with SH vs. SHantidepressants(imipramine) differs in the number of withdrawals for any given reason(1 RCT; N=43; Mitchell, 1990 243 ; RR: 0.48; 95% CI: 0.05 to 4.88).There is insufficient evidence to determine whether treatment with NC differs fromtreatment with NC-antidepressants (fluoxetine) in the number of withdrawals for anygiven reason at treatment completion (RR=0.66; 95% CI: 0.29 to 1.49) or due to adverseeffects (RR: 0.11; 95% CI: 0.01 to 2.04) according to 1 RCT (N=67; Beumont, 1987) 294 .An RCT (Goldbloom, 1997) 323 compared fluoxetine vs. fluoxetine-CBT. There were 2withdrawals due adverse effects in the fluoxetine group and four in the combinationfluoxetine-CBT.In an RCT (Walsh, 2004) 328 , there was a 54% withdrawal rate in the group treated withfluoxetine-GSH vs. 88% in the group treated with placebo-GSH vs. 70% in the grouptreated with fluoxetine vs. 64% in the placebo group. Adverse effects were not reported.In an RCT (Mitchell, 2001) 258 , the number of withdrawals was low: placebo (5%),fluoxetine (0%), placebo-SH (0%), fluoxetine-SH (5%). No adverse effects werereported.In 2 RCTs (Agras, 1992 324 ; Agras, 1994 325 ), no information was reported regardingadverse effects. The mean withdrawal rate was 25%.In 2 RCTs (Walsh, 1997 233 ;Wilson, 1999 326 ), the mean withdrawal rate was 34%, and noinformation was provided on adverse effects.In an RCT (Mitchell, 2002) 327 , no information was provided on adverse effects. Thepercentage of withdrawals was 32% in the IPT group and 48% in the antidepressantsgroup.RCT1++RCT1++RCT1++RCT1++RCT1+RCT1++RCT1+RCT1+RCT1++RCT1+Summary of the EvidenceCPG30When these therapies were implemented in primary care, the number ofwithdrawals in the group treated wit fluoxetine was 70%, higher than the 54%observed in the group treated with fluoxetine-GSH (Walsh, 2004) 328 .167CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS