First Combination Therapy For Bulimia

Drug treatment for the eating disorder bulimia may be improved by combining a selective serotonin reuptake inhibitor antidepressant with the opioid antagonist naltrexone, according to a new study presented on June 27 at the Collegium Internationale Neuropsycho-pharmacologicum meeting in Melbourne, Australia.

The new study involved 94 bulimics who were randomly assigned to treatment with either placebo, Eli Lilly's SSRI Prozac (fluoxetine), the opioid antagonist naltrexone, or both fluoxetine and naltrexone in combination. After six months' treatment, the patients were assessed using a clinical rating scale (BITE), and were deemed to have responded to treatment if they exhibited a 50% or more reduction in BITE score compared to baseline.

Prof Alessandro Bandecchi of the Neurosciences Institute in Arezzo, Italy, the lead investigator for the study, told the conference that the combination of fluoxetine and naltrexone achieved a response rate of around 70%, compared to 30% for fluoxetine alone, 11% for naltrexone alone and 8% for placebo. Fluoxetine and the combination group performed significantly better than placebo (p=0.01 and p=0.001 respectively), but naltrexone alone was not significantly better. The fluoxetine data were consistent with other studies which have suggested a 30%-40% response rate with SSRI monotherapy in bulimia.