Skip to main content
SpringerLink
Log in

Citalopram versus fluoxetine for the treatment of patients with bulimia nervosa: A single-blind randomized controlled trial

  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

The most studied and most frequently used pharmacologic treatments in bulimia nervosa are the selective serotonin reuptake inhibitors (SSRIs), in particular, fluoxetine. Less is known about the efficacy of the other SSRIs. To compare fluoxetine with citalopram in the treatment of bulimic patients, 37 bulimic patients were randomized to receive fluoxetine (n=18) or citalopram (n=19); these patients were assessed with regard to clinical (ie, body mass index, pathologic behaviors), psychopathologic (Eating Disorder Inventory-2, Body Shape Questionnaire, Binge-Eating Scale, Beck Depression Inventory), personality (Temperament and Character Inventory), and clinical global impression measures. These measures were compared between the 2 treatment groups at baseline and at the end of treatment. Dropout rates were similar in the 2 groups. Both groups showed significant improvement in eating psychopathology, angry feelings, and clinical global impression. Patients in the fluoxetine group displayed a greater reduction in introjected anger, whereas those in the citalopram group displayed a greater reduction in depressive feelings. Both treatments showed some effect on outcome measures, but efficacy profiles did not overlap. Citalopram may be useful in depressed patients with bulimia, whereas fluoxetine is more specific for those with introjected anger and bulimia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC: APA; 1994.

    Google Scholar 

  2. Ricca V, Mannucci E, Mezzani B, et al. Cognitive-behavioral therapy versus combined treatment with group psychoeducation and fluoxetine in bulimic outpatients.Eat Weight Disord. 1997; 2:94–99.

    PubMed  CAS  Google Scholar 

  3. Wilson GT, Loeb KL, Walsh BT, et al. Psychological versus pharmacological treatments of bulimia nervosa: predictors and processes of change.J Consult Clin Psychol. 1999;67:451–459.

    Article  PubMed  CAS  Google Scholar 

  4. Brambilla F, Draisci A, Peirone A, Brunetta M. Combined cognitive-behavioral, psychopharmacological and nutritional therapy in bulimia nervosa.Neuropsychobiology. 1995;32:68–71.

    Article  PubMed  CAS  Google Scholar 

  5. Mitchell JE, Fletcher L, Hanson K, et al. The relative efficacy of fluoxetine and manual-based self-help in the treatment of outpatients with bulimia nervosa.J Clin Psychopharmacol. 2001; 21:298–304.

    Article  PubMed  CAS  Google Scholar 

  6. Hay P, Bacaltchuck J, Stefano S. Psychotherapy for bulimia nervosa and binging.Cochrane Database Syst Rev. 2004;(3):CD000562.

  7. Goldstein DJ, Wilson MG, Thompson VL, Potvin JH, Rampey AH (Fluoxetine Bulimia Nervosa Research Group). Long-term fluoxetine treatment of bulimia nervosa.Br J Psychiatry. 1995;166: 660–666.

    PubMed  CAS  Google Scholar 

  8. Mitchell JE, Raymond N, Specker S. A review of the controlled trials of pharmacotherapy and psychotherapy in the treatment of bulimia nervosa.Int J Eat Disord. 1993;14:229–247.

    Article  PubMed  CAS  Google Scholar 

  9. Goldbloom DS, Olmsted M, Davis R, et al. A randomized controlled trial of fluoxetine and cognitive behavioral therapy for bulimia nervosa: short-term outcome.Behav Res Ther. 1997; 35:803–811.

    Article  PubMed  CAS  Google Scholar 

  10. American Psychiatric Association. Practice guideline for the treatment of patients with eating disorder (revision).Am J Psychiatry. 2000;157(suppl):1–39.

    Google Scholar 

  11. Bacaltchuck J, Hay P. Antidepressants versus placebo for people with bulimia nervosa.Cochrane Database Syst Rev. 2003;(4):CD003391.

  12. Walsh BT, Agras WS, Devlin MJ, et al. Fluoxetine for bulimia nervosa following poor response to psychotherapy.Am J Psychiatry. 2000;157:1332–1334.

    Article  PubMed  CAS  Google Scholar 

  13. Kotler LA, Devlin MJ, Davies M, Walsh BT. An open trial of fluoxetine for adolescent with bulimia nervosa.J Child Adolesc Psychopharmacol. 2003;13:329–335.

    Article  PubMed  Google Scholar 

  14. Rossi A, Barraco A, Donda P. Fluoxetine: a review on evidence based medicine.Ann Gen Hosp Psychiatry. 2004;12:2.

    Article  Google Scholar 

  15. Walsh BT, Fairburn CG, Mackley D, Sysko R, Parides MK. Treatment of bulimia nervosa in a primary care setting.Am J Psychiatry. 2004;161:556–561.

    Article  PubMed  Google Scholar 

  16. Romano SJ, Halmi KA, Sarkar NP, Koke SC, Lee JS. A placebo-controlled study of fluoxetine in continued treatment of bulimia nervosa after successful acute fluoxetine treatment.Am J Psychiatry. 2002;159:96–102.

    Article  PubMed  Google Scholar 

  17. Calandra C, Gulino V, Inserra L, Giuffrida A. The use of citalopram in an integrated approach to the treatment of eating disorders: an open study.Eat Weight Disord. 1999;4:207–210.

    PubMed  CAS  Google Scholar 

  18. Frank GK, Kaye WH, Marcus MD. Sertraline in underweight binge eating/purging-type eating disorders: five case reports.Int J Eat Disord. 2001;29:495–498.

    Article  PubMed  CAS  Google Scholar 

  19. Fichter MM, Leibl K, Rief W, Brunner E, Schmidt-Auberger S, Engel RR. Fluoxetine versus placebo: a double-blind study with bulimic inpatients undergoing intensive psychotherapy.Pharmacopsychiatry. 1991;24:1–7.

    PubMed  CAS  Google Scholar 

  20. Bezclibnyk-Butler K, Aleksic I, Kennedy SH. Citalopram—a review of pharmacological and clinical effects.J Psychiatry Neurosci. 2000;25:241–254.

    Google Scholar 

  21. Pallanti S, Quercioli L, Ramacciotti A. Citalopram in anorexia nervosa.Eat Weight Disord. 1997; 2:216–221.

    PubMed  CAS  Google Scholar 

  22. Fassino S, Leombruni P, Abbate-Daga G, et al. Efficacy of citalopram in anorexia nervosa: a pilot study.Eur Neuropsychopharmacol. 2002;12:453–459.

    Article  PubMed  CAS  Google Scholar 

  23. Appolinario JC, McElroy SL. Pharmacological approaches in the treatment of binge eating disorder.Curr Drug Targets. 2004;5:301–307.

    Article  PubMed  CAS  Google Scholar 

  24. McElroy SL, Hudson JI, Malhotra S, Welge JA, Nelson EB, Keck PE Jr. Citalopram in the treatment of binge-eating disorder: a placebo controlled trial.J Clin Psychiatry. 2003;64:807–813.

    Article  PubMed  CAS  Google Scholar 

  25. Carter WP, Hudson JI, Lalonde JK, Pindick L, McElroy SL, Pope HG Jr. Pharmacologic treatment of binge eating disorder.Int J Eat Disord. 2003;34(suppl):S74-S88.

    Article  PubMed  Google Scholar 

  26. Montgomery SA. Alternatives to placebo-controlled trials in psychiatry.Eur Neuropsychopharmacol. 1999;9:265–269.

    Article  PubMed  CAS  Google Scholar 

  27. First MB, Spitzer RL, Gibbon M, Williams JB.Structured Clinical Interview for DSM-IV Axis II Disorders. New York: Biometric Research, New York State Psychiatric Institute; 1995.

    Google Scholar 

  28. Cloninger CR, Przybeck TR, Svrakic DM, Wetzel RD.The Temperament and Character Inventory: A Guide to Its Development and Use. St. Louis, Mo: Center for Psychobiology of Personality; 1994.

    Google Scholar 

  29. Svrakic D, Stanic S, Fassino S, Cloninger CR. Classification of personality disorders: implications for treatment and research. Part I: Psychobiology of temperament and character. In: Soares JC, Gershon S, eds.Handbook of Medical Psychiatry. New York, NY: Marcel Dekker; 2003:117–148.

    Google Scholar 

  30. Garner DM.Eating Disorder Inventory 2: Professional Manual. Odessa, Fla: Psychological Assessment Resources Inc; 1993.

    Google Scholar 

  31. Cooper PJ, Taylor MJ, Cooper Z, Fairburn CG. The development and validation of the Body Shape Questionnaire.Int J Eat Disord. 1987;6:485–494.

    Article  Google Scholar 

  32. Beck AT, Rial WY, Rickets K. Short form of depression inventory: cross-validation.Psychological Reports. 1974;34:1184–1186.

    PubMed  CAS  Google Scholar 

  33. Groth-Marnat G.Handbook of Psychological Assessment. 2nd ed. New York, NY: John Wiley & Sons; 1990.

    Google Scholar 

  34. Greeno CG, Wing RR. A double blind, placebo-controlled trial of the effect of fluoxetine on dietary intake in overweight women with and without binge-eating disorder.Am J Clin Nutr. 1996;64:267–271.

    PubMed  CAS  Google Scholar 

  35. Ricca V, Mannucci E, Mezzani B, et al. Fluoxetine and fluvoxamine combined with individual cognitive-behavior therapy in binge eating disorder: a 1 year follow-up study.Psychother Psychosom. 2001;70:298–306.

    Article  PubMed  CAS  Google Scholar 

  36. Spielberger CD.State-Trait Anger Expression Inventory: Professional Manual. Odessa, Fla: Psychological Assessment Resources; 1996.

    Google Scholar 

  37. Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character.Arch Gen Psychiatry. 1993;50:975–990.

    PubMed  CAS  Google Scholar 

  38. Guy W, Bonato RS, Cleary P, Yang K, Levine J. A data processing system for psychotropic drug evaluation.Arch Gen Psychiatry. 1970;23:454–463.

    PubMed  CAS  Google Scholar 

  39. SPSS (Statistical Package for the Social Sciences).Base 8.0: Application Guide. Chicago: SPSS; 1998.

    Google Scholar 

  40. Fassino S, Abbate-Daga G, Pierò A, Leombruni P, Rovera GG. Anger and personality in eating disorders.J Psychosom Res. 2001;51:757–764.

    Article  PubMed  CAS  Google Scholar 

  41. Sonawalla SB, Farabaugh A, Johnson MW, et al. Fluoxetine treatment of depressed patients with comorbid anxiety disorders.J Psychopharmacol. 2002;16:215–219.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosciences Section of Psychiatry, University of Turin S. Giovanni Battista Hospital, Turin, Italy

    Paolo Leombruni MD, Federico Amianto MD, Nadia Delsedime MD, Carla Gramaglia MD, Giovanni Abbate-Daga MD & Secondo Fassino MD

Authors
  1. Paolo Leombruni MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Federico Amianto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nadia Delsedime MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carla Gramaglia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giovanni Abbate-Daga MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Secondo Fassino MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leombruni, P., Amianto, F., Delsedime, N. et al. Citalopram versus fluoxetine for the treatment of patients with bulimia nervosa: A single-blind randomized controlled trial. Adv Therapy 23, 481–494 (2006). https://doi.org/10.1007/BF02850170

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02850170

Keywords

Search

Navigation