Treatment of bulimia nervosa in a primary care setting.
OBJECTIVE
The authors' goal was to determine whether treatments known to be effective for bulimia nervosa in specialized treatment centers can be used successfully in primary health care settings. They examined the benefits of two treatments for bulimia: 1) fluoxetine, an antidepressant medication, and 2) guided self-help, an adaptation of cognitive behavior therapy.


METHODS
Ninety-one female patients in two primary care settings were randomly assigned to receive fluoxetine alone, placebo alone, fluoxetine plus guided self-help, or placebo and guided self-help.


RESULTS
The majority of the patients did not complete the treatment trial; many patients found the treatment program too demanding, but others indicated it was not sufficiently intensive. Patients assigned to fluoxetine attended more physician visits, exhibited a greater reduction in binge eating and vomiting, and had a greater improvement in psychological symptoms than those assigned to placebo. There was no evidence of benefit from guided self-help.


CONCLUSIONS
The treatment of patients with bulimia nervosa in a primary care setting is hampered by a high dropout rate. Guided self-help, a psychological treatment based on cognitive behavior therapy, appears ineffective, but treatment with fluoxetine is associated with better retention and substantial symptomatic improvement.
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA. btw1@columbia.edu
B Timothy
BT
Walsh
Christopher G
CG
Fairburn
Diane
D
Mickley
Robyn
R
Sysko
Michael K
MK
Parides
D000328:Adult; D002032:Bulimia / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D010348:Patient Care Team; D011320:Primary Health Care; D011380:Programmed Instructions as Topic; D012648:Self Care / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors