One-year follow-up of psychosocial and pharmacologic treatments for bulimia nervosa.
BACKGROUND
This study examined the outcome 1-year posttreatment of the use of desipramine, cognitive-behavioral therapy (CBT), and their combination in the treatment of bulimia nervosa.


METHODS
Sixty-one patients meeting DSM-III-R criteria for bulimia nervosa were randomly assigned to one of five groups--desipramine (withdrawn at 16 or 24 weeks), CBT (18 sessions), or the combined treatment (18 sessions of CBT plus desipramine withdrawn at 16 or 24 weeks)--and were followed to 1-year posttreatment.


RESULTS
At 1-year follow-up, both the combined 24-week treatment and CBT alone were significantly superior in reducing binge eating to desipramine given for 16 weeks. The combined treatment was also superior to 16 weeks of desipramine in reducing emotionally driven eating and dietary restraint. Only 18% (2 of 11) of those receiving 16 weeks of desipramine were free of binge eating and purging at follow-up compared with 78% (7 of 9) of those receiving the combined 24-week treatment. The other groups fell between these two extremes.


CONCLUSIONS
With the exception of the group treated for 16 weeks with desipramine alone, maintenance of improvement appeared satisfactory with all the treatments. Since the poorest results were found with 16 weeks of desipramine treatment, this study suggests that desipramine should be continued for at least 24 weeks either alone or combined with CBT. The broadest gain in reducing the psychopathology associated with bulimia nervosa was found with the combined 24-week treatment.
Agras
W S
WS
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305.
Rossiter
E M
EM
Arnow
B
B
Telch
C F
CF
Raeburn
S D
SD
Bruce
B
B
Koran
L M
LM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001835:Body Weight; D002032:Bulimia / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003891:Desipramine / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005247:Feeding Behavior / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome
D003891:Desipramine