Psychological Medicine

Original Articles

Early response to antidepressant treatment in bulimia nervosa

R. Syskoa1a2 c1, N. Shaa3, Y. Wanga3a4, N. Duana1a3a4 and B. T. Walsha1a2

a1 Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA

a2 Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA

a3 Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA

a4 Division of Biostatistics and Data Coordination, New York State Psychiatric Institute, New York, NY, USA


Background Bulimia nervosa (BN) is a serious psychiatric disorder characterized by frequent episodes of binge eating and inappropriate compensatory behavior. Numerous trials have found that antidepressant medications are efficacious for the treatment of BN. Early response to antidepressant treatment, in the first few weeks after medication is initiated, may provide clinically useful information about an individual's likelihood of ultimately benefitting or not responding to such treatment. The purpose of this study was to examine the relationship between initial and later response to fluoxetine, the only antidepressant medication approved by the US Food and Drug Administration (FDA) for the treatment of BN, with the goal of developing guidelines to aid clinicians in deciding when to alter the course of treatment.

Method Data from the two largest medication trials conducted in BN (n=785) were used. Receiver operating characteristic (ROC) curves were constructed to assess whether symptom change during the first several weeks of treatment was associated with eventual non-response to fluoxetine at the end of the trial.

Results Eventual non-responders to fluoxetine could be reliably identified by the third week of treatment.

Conclusions Patients with BN who fail to report a 60% decrease in the frequency of binge eating or vomiting at week 3 are unlikely to respond to fluoxetine. As no reliable relationships between pretreatment characteristics and eventual response to pharmacotherapy have been identified for BN, early response is one of the only available indicators to guide clinical management.

(Received May 19 2009)

(Revised July 24 2009)

(Accepted July 25 2009)

(Online publication September 15 2009)


c1 Address for correspondence: Dr R. Sysko, Columbia Center for Eating Disorders, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA. (Email:


Presented in part at the 14th Annual Meeting of the Eating Disorder Research Society, 25–27 September 2008, Montreal, Canada, and the 42nd Annual Meeting of the Association for Behavioral and Cognitive Therapies, 13–16 November 2008, Orlando, FL, USA.