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

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Background: This review assessed the effect of a combination of antidepressants plus psychological approaches compared to each single treatment for bulimia nervosa. Methods: 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. Results: Five trials were included in meta‐analysis 1 and 7 in meta‐analysis 2. Remission rates (RR) 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). Conclusion: Efficacy of combined treatments was superior to single approaches. When antidepressants were combined to treatment, acceptability of psychological approaches was significantly reduced.

Keywords: antidepressants; bulimia nervosa; meta‐analysis; psychotherapy; systematic review

Document Type: Research Article


Affiliations: 1: Federal University of São Paulo, UNIFESP‐EPM, São Paulo, Brazil, 2: Federal University of Bahia, Salvador, Brazil, 3: University of Adelaide, Adelaide, Australia and 4: Federal University of Pelotas, Brazil

Publication date: April 1, 2000


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