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Acta Psychiatr Scand. 2000 Apr;101(4):256-64.

Combination of antidepressants and psychological treatments for bulimia nervosa: a systematic review.

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  • 1Federal University of São Paulo, UNIFESP-EPM, Brazil.


This review assessed the effect of a combination of antidepressants plus psychological approaches compared to each single treatment for bulimia nervosa.


Trials were included in two meta-analyses: single antidepressants versus combination and single psychological approaches versus combination. Methodological quality and homogeneity of results were assessed. Dichotomous outcomes were analysed by calculating relative risks (RR).


Five trials were included in meta-analysis 1 and 7 in meta-analysis 2. Remission rates were 42% for combination versus 23% for antidepressants (RR = 1.38; 95% CI=0.98-1.93; P=0.06) and 36% for psychological approaches compared to 49% for combination (RR= 1.21; P=0.03). Drop-out rates were 16% for psychological approaches and 30% for combination (RR =0.57; 95% CI = 0.38-0.088; P=0.11).


Efficacy of combined treatments was superior to single approaches. When antidepressants were combined to treatment, acceptability of psychological approaches was significantly reduced.

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