Efficacia del citalopram nel trattamento della bulimia nervosa : uno studio randomizzato e controllato

Biomedical Research 2005; 16 (2): 85--87

Treatment of bulimia nervosa with citalopram: A randomized controlled
trial
W. Milano, C. Petrella, *A. Capasso

Unità Operativa di Salute Mentale Distretto 44 ASL NA1, Via Monte di Dio, 25. Napoli, Italy
*Department of Pharmaceutical Sciences, University of Salerno, via Ponte Don Melillo, Fisciano (Salerno), Italy
Key words: Bulimia nervosa, serotonin, SSRI
Abstract
Bulimia nervosa (BN) is one of the most frequent eating disorders in industrialized societies. Re-
duced serotonin activity has been suggested to trigger some of the cognitive and mood distur-
bances associated with BN. Therefore, pharmacological treatment of BN is mainly based on the use
of selective serotonin reuptake inhibitors, that have proved effective. The biological basis of this
disorder fully are not established yet.

The aim of this randomized controlled trial was to verify the efficacy of citalopram, a selective sero-
tonin reuptake inhibitor, in a group of BN diagnosed patients.

Twenty female outpatients, with an age range of 19-28 years having BN-binge purging, as defined by
the DSM IV, were assigned randomly into two treatment groups; the first group received 20-40
mg/day citalopram for 12 weeks and the second group had placebo. The study was conducted for 12
weeks with weekly clinical assessments.

At the end of the observation period, the group treated with citalopram showed a statistically signifi-
cant reduction in the number of binge-eating crisis and purging with respect to the group who re-
ceived the placebo only. In no case, treatment was interrupted for any emergency reasons.

This study indicates that citalopram is well tolerated and equally effective in reducing binge-eating
crisis and purging in patients with BN

Introduction
Stuncard in the ‘50s) regarding the quantities of food taken and patient’s lack of control on eating impulse (criterion A). The term bulimia nervosa (BN) refers to an eating behaviour characterised by episodes of convulsive greedy uncontrolled Moreover, the DSM IV identifies two subtypes: with eating be- ingestion of high caloric and easy-taking food in great quantities. haviours (self-induced vomiting, misuse of laxatives or diuretics, Compensatory behaviours to control the weight often follow etc.) and without purging behaviours, when the patient uses these episodic crises, such as self-induced vomiting or laxatives fasting or excessive physical exercises and no medicines or vomiting (criterion B). The first type is obviously the most seri- Even if the bulimic patient has nearly normal weight or of slightly excess, its stability is very fragile because the idea of putting on The clinical complications of BN are mainly linked to the chaos in eating, but especially to the compensatory episodes which can provoke side effects, such as the erosion of the dental In 1980 the DSM III included the BN in the official diagnostic eamel or the inflammation of the esophageal mucosa, up to hy- nomenclature. In 1994 the DSM IV defined the peculiarities of dro-electrolytic imbalances which can cause arrhythmia, cardiac the bulimic crisis (binge-eating – the term first used by Albert The bulimic patients show nearly always mood disorders (de- Results and Discussion
pression), abnormal behaviours such as alcohol or drugs misus- ing, self-damaging behaviour, panic crisis, obsessive-compul- Following eight weeks of treatment, the group given citalopram showed 65% reduction in the bulimic seizures and 56% de- crease in the purging behaviours. The average caloric intake Recent theories refer to BN as a serotoninergic system disfunc- was decreased into 7%, and there was a strong reduction in the tion. The serotonin (5HT) concentration declines in the cerebro- glicide rate. The patients lost about 5% of their body weight spinal fluid of those bulimic patients who show more binge- eating behaviours. The serotoninergic theory also explains other psycho-pathologic aspects which are often linked to the eating The second group with placebo showed 12% reduction in the bulimic seizures and 7% decrease in the purging behaviours. The average caloric intake and body weight showed no signifi- This hypothesis possibly provokes the use of anti-depression psychotropic drugs as symptomatologic therapy in BN. In recent years, selective inhibitor of serotonin’s reuptake (SSRI) is fa- During the course of treatment, the following side effects were The group given citalopram showed 38% sedation, 24% Our study aims at testing the efficacy of citalopram the most se- mouth dryness, 6% nausea and 3% headache. lective SSRI, in symptomatologic treatment of BN. The group which had placebo showed 9% headache, 12% light asthenia and 5% sedation (Table 1). Materials and Methods
None of the patient went out of the trial because of serious side effects. The study included 20 female patients, aged between 19 and 28 who suffered from BN with purging behaviours (BN - binge purg- Our results therefore suggest that the use of citalopram in the ing) according to the DSM IV and the BITE scale’s diagnostic symptomatological treatment of BN has a prononced clinic criteria. The patients, with their consent, were randomly divided value. The bulimic patients who were given citalopram have, into two groups of 10 women in each. The patients in the first indeed, showed a statistically significant decrease both in binge- group were given citalopram of 20 mg/day for the first week and eating crises and purging episodes, together with a reduced cra- 40 mg/day during the following seven weeks. The patients in the ving for carbohydrates and, even if indirectly, a modest average second group were given placebo. The study went on for eight caloric intake, which has caused a slight weight loss at the end weeks. All patients were subjected to clinical check-up (twice-a- of the trial. Moreover, no patient treated with citalopram or pla- week for the period of 8 weeks) in order to monitor the clinical cebo suffered from any drug-induced side effects. These encou- development and the possible side effects if any. The patients raging results therefore us to suggest that the use of citalopram had maintained an accurate diary of their food choices, bulimic in the symptomatological treatment of BN is as an effective al- seizures, weight and the possible compensatory behaviours. Table 1: The effects of citalopram vs placebo in BN
Clinical Effects
Citalopram Treated Patients
Placebo Treated Patients

References
1. Muscettola G, Casiello M. Psicofarmacologia dei disordini del comportamento alimentare. In: Bellan tuono, Balestrino Glips icofarmaci: farmacologia e terapia. Pensiero Scientifico 2. American Psychiatric Association. Diagnostic and Manual 3. Walsh T, Devlin M. Eating disorders: progress and prob 4. Cuzzolaro M, Magnani M. Obesità e disturbi del com porta mento alimentare. In: Borsello O. Obesità Ed Kurtis 1998; 5. Bellodi L, Brambilla F. Eating disorders and obsessive compulsive disorders: an pathogenetic link? Centro Scientif 6. Brewerton TD. Toward a unifed theory of serotonin dysregu lation in eating and related disorders.Psycho endocrinol 7. Ramacciotti C. Terapia farmacologica della Bulimia Ner 8. Liebbowiz SF et al. Brain serotonin and eating behav- 9. Jiemeron DC et al.: Decreased serotonin function in B.N. 10. Muller E, Brambilla F. Disordini del comportamento alimen 11. Devane CL Comparative safety and tolerability of SSRI. Human Psychopharmacology 1995; 10: 185-193 12. Henderson M, Freeman CP. A Self-rating scale for bu limia. The BITE. Brit Jour Psychtr 1987; 150: 18-24. 13. American Psychiatric Association: Practice guideline for the treatment of patients with eating disorder. Am J Psychiatry 14. Kay WH: Serotonin regulation in bulimia. The psycho- biology of bulimia. In: Hudsen J Editor 1987; 2: 54-66. Correspondence:


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