Article Summary: duloxetine tx of bulimia, case study.

Thanks to Crystal B. for this article.

Successful Treatment with duloxetine in a case of treatment refractory bulimia nervosa: a case report
Fluoxetine (an SSRI) has been the treatment used for bulimia nervosa for quiet some time. This was possible due to its ability of changing serotonin activity in the brain. However having the disease of bulimia disrupts neurotransmitters and neuropeptide systems which cause the drugs affect to be weakened. Norepinephrine activity changes as well with this disorder which leads to evidence that medications that affect norepinephrine system may be effective.
Knowing that both SSRIs and NRIs show efficacy in treatment it is logical to conclude that a combination of serotonin and noreprinephrine reuptake inhibitor (SNRI) may be a possible approach towards treatment. There is however little data to support this idea.
Duloxetine, an SNRI has been used for those suffering from Major Depressive Disorder. Although there is no significant data for the drug being effective with bulimia, one female patient’s success is paving the way for further research.
This 33 year old was first treated at Mass General Hospital for depression. Her preoccupation with her weight began when she was 17years old. When presenting at the hospital she was bingeing and purging 3-4 times a week. She had no drug abuse or past psychiatric admissions. This patient was first treated with fluoxetine (up to 60mg a day). This lasted for two years but as time went on her depression and destructive eating behaviors returned.
She went through many different treatments for the next eight years. Four week trial of fluvoxamine- discontinued due to side effects. Paroxetine for six weeks, citalopram for four weeks and sertraline for six weeks. All treatments discontinued due to little benefit and intolerable side effects (primarily nausea).
After these trials, 30mg of duloxetine was prescribed a day. In two weeks the medication was tolerated and increased eventually to 120mg. The patient reported increased mood and complete remission of her bingeing and purging. Effects have persisted and she has been free of her adverse eating behaviors for sixteen weeks.