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. Author manuscript; available in PMC: 2021 Jun 30.
Published in final edited form as: Clin Ther. 2020 Dec 18;43(1):17–39. doi: 10.1016/j.clinthera.2020.10.006

Table 3.

Main findings from RCTS investigating combined psychotherapy and pharmacotherapy for BN

Study Treatment condition Attrition % Purging frequency Binge-eating frequency Depression Abstinence/Remission
Agras et al. (1992)[16]

  1. SSRI 16

  2. SSRI 24

  3. CBT+SSRI 16

  4. CBT + SSRI 24

  5. CBT 24
  • a/b)

    17%

  • c/d)

    4%

 Pre-, 16, 24, 32 wks:

  1. 9.7 to 4.7 to 5.0 to 6.2c,d,e

  2. 6.3 to 3.9 to 2.9 to 3.4 c,d,e

  3. 8.3 to 2.6 to 2.7 to 3.2 a,b

  4. 11.7 to 1.2 to 1.7 to 1.1 a,b

  5. 10.1 to 1.7 to 2.7 to 2.2 a,b

 Pre-, 16, 24, 32 wks:

  1. 5.5 to 3.5 to 3.7 to 6.2 c,d,e

  2. 5.9 to 3.4 to 2.7 to 3.3 c,d,e

  3. 7.5 to 2.4 to 2.1 to 3.2 c,d,e

  4. 9.3 to 1.7 to 2.3 to 1.0 a,b

  5. 8.7 to 1.5 to 2.8 to 2.5 a,b

 NA Purge abstinence, 16 wks:
  • a/b)

    33%e

  • c/d)

    64%e

  • e)

    48%abcd

Binge abstinence, 16 & 32 wks:
  • a/b)

    35, 42e

  • c/d)

    65, 70e

  • e)

    50, 55 abcd
Beumont et al. (1997)[25]

  1. Nutritional counseling + PL

  2. Nutritional counseling + SSRI

  1. 30%

  2. 50%

 Pre-, 8, and 20 wks:

  1. 7.3 to 2.3 to to 2.3

  2. 8.8 to 1.2 to 2.5

 Pre-, 8, and 20 wks:

  1. 6.1 to 1.2 to 1.9

  2. 10.1 to 1.6 to 2.2

 HAMD:

  1. 11.8 to 6.8

  2. 11.0 to 5.3

 Binge-abstinence at 8 wks and FUP:

  1. 61.5%, 60.9%

  2. 69.6%, 35.7%
Fahy et al. (1993)[17]

  1. CBT + d-fenfluramine

  2. CBT + placebo

  1. 0%

  2. 9.4%

 At pre- and 16 wks:

  1. 6.2 to 3.2

  2. 7.8 to 3.8

 At pre- and 16 wks:

  1. 6.6 to 3.4

  2. 5.1 to 2.4

 MADRS:

  1. 13.1 to 8.7

  2. 13.0 to 9.3

 No longer fulfilled DSM criteria for BN, total N:
8-wk: 54%
16-wk: 74%
Fichter et al. (1991)[26]

  1. Inpt psychotherapy+SSRI

  2. Inpatient psychotherapy + PL

  1. 0.0%

  2. 0.0%

 NA At pre- and post:

  1. 5.6 to 30

  2. 8.9 to 6.60

 HAMD:

  1. 13.3 to 8.3

  2. 14.1 to 11.1

 EDI Bulimia

  1. 10.2 to 3.0

  2. 9.9 to 4.0
Goldbloom et al. (1997)[18]

  1. CBT

  2. SSRI

  3. CBT + SSRI

  1. 33.3%

  2. 39.1%

  3. 56.9%

 Percent reduction:

  1. 79.2%b

  2. 37.4%a,c

  3. 82.4% b

 Percent reduction:

  1. 80%

  2. 70%

  3. 87%

 BDI:

  1. 18.4 to 13.8

  2. 16.3 to 13.6

  3. 14.8 to 7.5

 Percent abstinent from vomit + BE:

  1. 43%

  2. 17%

  3. 25%
Jacobi et al. (2002)[24]

  1. CBT

  2. SSRI

  3. CBT + SSRI

  1. 42%

  2. 25%

  3. 33%

  1. 16.4 to 28.5 to 11.3

  2. 22.7 to 37.9 to 15.5

  3. 15.3 to 14.7 to 21.6

Percent reduction, post-tx:

  1. 52%

  2. 35%

  3. 32%

  1. 17.4 to 13.5 to 8.9

  2. 20.5 to 34.9 to 12.7

  3. 9.0 to 13.5 to 14.8

Percent reduction, post-tx:

  1. 42%

  2. 46%

  3. 50%

 BDI:

  1. 16.8 to 10.9

  2. 16.0 to 14.4

  3. 17.2 to 13.9

 Percent abstinent from vomiting, binge eating at 1-year FUP:

  1. 20%, 40%

  2. 13%, 38%

  3. 11%, 11%
Leitenberg et al. (1994)[19]

  1. CBT

  2. Desipramine

  3. CBT + desipramine

  1. 14%

  2. 57%

  3. 28%

 Mean frequency vomiting at pre-, end, and 6-mo FUP:

  1. 9.3 to 0.3 to 0.9 *

  2. 9.2 to 8.2 to 7.2

  3. 7.1 to 1.7 to 1.7*

 EAT mean score:

  1. 41.6 to 14.7* to 12.6*

  2. 55.7 to 47.0 to 41.0

  3. 62.6 to 26.4* to 36.8

 IDD:

  1. 27.5 to 8.2 to 8.8*

  2. 32.0 to 21.0 to 21.0

  3. 36.2 to 18.2* to 19.8

 Percent abstinent from vomiting, post-tx:

  1. 71.4% (5 of 7)

  2. 0%

  3. 57.1% (4 of 7)
Mitchell et al. (1990)[27]

  1. Placebo

  2. Imipramine

  3. Intensive group therapy + placebo

  4. Intensive group therapy + imipramine

  1. 16.1%

  2. 32.6%

  3. 14.7%

  4. 25.0%

 Mean frequency vomiting, pre-post:

  1. 10.0 to 9.9 b,c,d

  2. 8.6 to 4.7 c,d

  3. 13.2 to 1.3 a,b

  4. 9.6 to 1.0 a,b

 Mean frequency binge eating, pre-post:

  1. 8.0 to 7.8 b,c,d

  2. 7.3 to 3.7 c,d

  3. 9.2 to 1.0 a,b

  4. 8.4 to 0.7 a,b

 HAMD-D, pre-post:

  1. 10.9 to 9.7 b,c,d

  2. 11.6 to 7.0 c,d

  3. 9.5 to 4.2 a,b

  4. 11.0 to 2.3 a,b

 EDI global score, pre-post:

  1. 68.9 to 64.0 b,c,d

  2. 67.4 to 49.6 c,d

  3. 60.9 to 28.5 c,d

  4. 66.1 to 26.2 b,c,d
Mitchell et al. (2001)[22]

  1. Placebo

  2. Fluoxetine

  3. CBTsh + Placebo

  4. CBTsh + Fluoxetine

  1. 5.5%

  2. 0.0%

  3. 0.0%

  4. 5.8%

 Percent reduction at endpoint and FUP:

  1. 22.8% and 21.8%

  2. 52.8% and 46.1%

  3. 50.2% and 31.5%

  4. 66.7% and 67.7%

* Med vs placebo and for gSH vs. no gSH		 Percent reduction at endpoint and FUP:

  1. 32.4% and 26.9%

  2. 50.3% and 43.4%

  3. 59.7% and 35.4%

  4. 66.8% and 61.6%

 HAM-D scores, pre:

  1. 10.9

  2. 8.85

  3. 10.1

  4. 8.1

NS time or group effects.		 Percent abstinent from vomiting + binge eating.

  1. NA

  2. 16%

  3. 24%

  4. 26%
Mitchell et al. (2011) [20]

  1. CBT

  2. Stepped care

  1. 19%

  2. 25%

 Frequency binge eating at pre-, post-, and FUP:

  1. 27 to 4 to 10

  2. 27 to 8 to 3

 Frequency compensatory pre, post, and FUP:

  1. 44 to 12 to 15

  2. 43 to 19 to 5

 BDI:

  1. 17.9 to 12.3 to 13.3

  2. 17.5 to 12.7 to 12.1

 Percent remitted (no longer meeting DSM criteria) at end of treatment and FUP:

  1. 57% and 44%

  2. 52% and 32%
Walsh et al. (1997)[21]

  1. CBT-SSRI

  2. CBT-placebo

  3. SPT-SSRI

  4. SPT-Placebo

  5. Medication

 34% overall Frequency:

  1. 10.8 to 1.1e

  2. 10.8 to 5.6d

  3. 10.6 to 5.5

  4. 11.9 to 7.5b

  5. 10.5 to 3.7a

 Frequency:

  1. 7.3 to 0.95 e

  2. 7.2 to 2.56 d

  3. 7.9 to 3.6

  4. 6.2 to 3.3 b

  5. 8.3 to 2.6 a

 BDI:

  1. 10.9 to 4.4

  2. 11.7 to 6.8

  3. 15.9 to 6.7

  4. 14.3 to 10.2

  5. 14.5 to 8.2

 Percent abstinent from vomiting + BE:

  1. 48%

  2. 20%

  3. 9%

  4. 14%

  5. 21%
Walsh et al. (2004)[23]

  1. Placebo

  2. Fluoxetine alone

  3. Placebo + gSH

  4. Med + gSH
  • a/b)

    66.6%

  • c/d)

    71.4%

  1. 17.3 to 12.5

  2. 18.3 to 11.2

  3. 20.7 to 10.3

  4. 19.3 to 17.2

  1. 15.5 to 9.9

  2. 16.6 to 8.1

  3. 20.70 to 10.1

  4. 17.9 to 13.9

 BDI:

  1. 18.4 to 15.9

  2. 18.4 to 10.4

  3. 19.6 to 17.2

  4. 19.7 to 12.5

 Percent abstinent from vomiting + BE:
  • a/b)

    9.5%

  • c/d)

    12.2%

Notes: BN = bulimia nervosa; FUP = follow-up; RCT = randomized controlled trial; SSRI = selective serotonin reuptake inhibitor; CBT = cognitive-behavior therapy; SPT = supportive psychotherapy; sh = self-help; gSH= guided self-help; DSM = Diagnostic and Statistical Manual of Mental Disorders; ns = not significant; IDD = Inventory to Diagnose Depression, EAT = Eating Attitudes Test, EDI = Eating Disorders Inventory; BDI = Beck Depression Inventory; HAMD = Hamilton Depression Inventory; BE = binge eating; NA = data not available. Subscripts denote significant group differences between treatments.