From the Guidelines
Fluoxetine (Prozac) is the most established medication for treating bulimia nervosa, typically prescribed at 60 mg per day, and should be combined with psychotherapy, particularly cognitive behavioral therapy (CBT), for optimal results. According to the American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1, adults with bulimia nervosa should be treated with eating disorder-focused cognitive-behavioral therapy and a serotonin reuptake inhibitor, such as fluoxetine, either initially or if there is minimal or no response to psychotherapy alone by 6 weeks of treatment.
Some key points to consider when treating bulimia nervosa with medication include:
- The dosage of fluoxetine is typically higher than that used for depression, at 60 mg per day 1
- Treatment usually continues for at least 6-12 months, though many patients benefit from longer treatment
- Other selective serotonin reuptake inhibitors (SSRIs) like sertraline, citalopram, and escitalopram may also be effective
- Medication alone is rarely sufficient treatment; a comprehensive approach including therapy, nutritional counseling, and possibly medication offers the best chance of recovery
- Side effects of SSRIs may include nausea, headache, sleep disturbances, and sexual dysfunction, but these often improve with time
It's essential to work with healthcare providers experienced in eating disorders to develop an individualized treatment plan, as the balance of benefits and harms of different interventions can be difficult to judge, and patient values and preferences may be more variable 1.
From the FDA Drug Label
The efficacy of Prozac was established in 8– to 16–week trials for adult outpatients with moderate to severe bulimia nervosa, i.e., at least 3 bulimic episodes per week for 6 months Prozac is indicated for the treatment of binge–eating and vomiting behaviors in patients with moderate to severe bulimia nervosa The recommended dose is 60 mg/day, administered in the morning.
Fluoxetine (Prozac) is the medication that helps with bulimia nervosa (eating disorder), with a recommended dose of 60 mg/day. 2
From the Research
Medications for Bulimia Nervosa
The following medications have been studied for their effectiveness in treating bulimia nervosa:
- Fluvoxamine: a selective serotonin reuptake inhibitor (SSRI) that has been shown to be effective in reducing binge-eating crises and purging episodes in patients with bulimia nervosa 3
- Fluoxetine: an SSRI that has been found to be safe and effective in treating patients with bulimia nervosa, resulting in significant reductions in vomiting and binge-eating episodes per week 4, 5, 6, 7
Key Findings
- Fluvoxamine has been shown to be well tolerated and effective in reducing binge-eating crises and purging episodes in patients with bulimia nervosa 3
- Fluoxetine has been found to be effective in treating bulimia nervosa, with significant reductions in vomiting and binge-eating episodes per week 4, 5
- A two-stage medication intervention using fluoxetine has been shown to add modestly to the benefit of psychological treatment for bulimia nervosa 6
- Cognitive-behavioral therapy plus medication (fluoxetine) has been found to be superior to medication alone in treating bulimia nervosa 6