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Early response to antidepressant treatment in bulimia nervosa

  • R. Sysko (a1) (a2), N. Sha (a3), Y. Wang (a3) (a4), N. Duan (a1) (a3) (a4) and B. T. Walsh (a1) (a2)...

Bulimia nervosa (BN) is a serious psychiatric disorder characterized by frequent episodes of binge eating and inappropriate compensatory behavior. Numerous trials have found that antidepressant medications are efficacious for the treatment of BN. Early response to antidepressant treatment, in the first few weeks after medication is initiated, may provide clinically useful information about an individual's likelihood of ultimately benefitting or not responding to such treatment. The purpose of this study was to examine the relationship between initial and later response to fluoxetine, the only antidepressant medication approved by the US Food and Drug Administration (FDA) for the treatment of BN, with the goal of developing guidelines to aid clinicians in deciding when to alter the course of treatment.


Data from the two largest medication trials conducted in BN (n=785) were used. Receiver operating characteristic (ROC) curves were constructed to assess whether symptom change during the first several weeks of treatment was associated with eventual non-response to fluoxetine at the end of the trial.


Eventual non-responders to fluoxetine could be reliably identified by the third week of treatment.


Patients with BN who fail to report a ⩾60% decrease in the frequency of binge eating or vomiting at week 3 are unlikely to respond to fluoxetine. As no reliable relationships between pretreatment characteristics and eventual response to pharmacotherapy have been identified for BN, early response is one of the only available indicators to guide clinical management.

Corresponding author
*Address for correspondence: Dr R. Sysko, Columbia Center for Eating Disorders, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA. (Email:
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WS Agras , SJ Crow , KA Halmi , JE Mitchell , GT Wilson , HC Kraemer (2000). Outcome predictors for the cognitive behavior treatment of bulimia nervosa: data from a multisite study. American Journal of Psychiatry 157, 13021308.

AE Becker , DW Mickley , JL Derenne , A Klibanski (2008). Eating disorders: evaluation and management. In Massachusetts General Hospital: Comprehensive Clinical Psychiatry (ed. T. A. Stern , J. F. Rosenbaum , M. Fava , J. Biederman and S. L. Rauch ), pp. 499518. Mosby, Inc: Philadelphia, PA.

CG Fairburn , WS Agras , BT Walsh , GT Wilson , E Stice (2004). Prediction of outcome in bulimia nervosa by early change in treatment. American Journal of Psychiatry 161, 23222324.

DJ Goldstein , MG Wilson , VL Thompson , JH Potvin , AH Rampey (1995). Long-term fluoxetine treatment of bulimia nervosa. British Journal of Psychiatry 166, 660666.

CM Grilo , RM Masheb (2007). Rapid response predicts binge eating and weight loss in binge eating disorder: findings from a controlled trial of orlistat with guided self-help cognitive behavioral therapy. Behaviour Research and Therapy 45, 25372550.

CM Grilo , RM Masheb , GT Wilson (2006). Rapid response to treatment for binge eating disorder. Journal of Consulting and Clinical Psychology 74, 602613.

BJ Kinon , L Chen , H Ascher-Svanum , VL Stauffer , S Kollack-Walker , JL Sniadecki , JM Kane (2008). Predicting response to atypical antipsychotics based on early response in the treatment of schizophrenia. Schizophrenia Research 102, 230240.

RM Masheb , CM Grilo (2007). Rapid response predicts treatment outcomes in binge eating disorder: implications for stepped care. Journal of Consulting and Clinical Psychology 75, 639644.

RM McFall , TA Treat (1999). Quantifying the information value of clinical assessments with signal detection theory. Annual Review of Psychology 50, 215241.

NA Obuchowski (2006). An ROC-type measure of diagnostic accuracy when the gold standard is continuous-scale. Statistical Medicine 25, 481493.

MH Pollack , SG Kornstein , ME Spann , P Crits-Christoph , J Raskin , JM Russell (2008). Early improvement during duloxetine treatment of generalized anxiety disorder predicts response and remission at endpoint. Journal of Psychiatric Research 42, 11761184.

JR Shapiro , ND Berkman , KA Brownley , JA Sedway , KN Lohr , CM Bulik (2007). Bulimia nervosa treatment: a systematic review of randomized controlled trials. International Journal of Eating Disorders 40, 321336.

A Szegedi , WT Jansen , AP van Willigenburg , E van der Meulen , HH Stassen , ME Thase (2009). Early improvement in the first 2 weeks as a predictor of treatment outcome in patients with major depressive disorder: a meta-analysis including 6562 patients. Journal of Clinical Psychiatry 70, 344353.

BT Walsh , R Sysko , MK Parides (2006). Early response to medication among women with bulimia nervosa. International Journal of Eating Disorders 39, 7275.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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