Unlike psychotherapy, the impacts of pharmacological treatments for bulimia nervosa are small to moderate and have not been found to continue after cessation of medication [1454]. However, studies that have examined the combined use of pharmacotherapies (mostly SSRIs) and psychotherapies (mostly CBT) , have generally found this combined approach to demonstrate similar effectiveness to psychotherapy alone, but results are not consistent [1454].
Most treatment guidelines for single disorder bulimia nervosa recommend the use of SSRIs (specifically fluoxetine) in combination with psychotherapy [1434, 1457]. Although meta-analyses and other reviews have found that SSRIs appear to be less effective than TCAs and MAOIs (such as those listed in Table 47) [1454, 1458, 1459], their side effect profile is often more tolerable [1449]. As mentioned previously, extreme caution should be used when prescribing TCAs and MAOIs.
In addition to antidepressants, Australian guidelines for the treatment of ED recommend the use of the antiepileptic topiramate when psychological treatment is not available [870]. There is also some evidence from open label trials of lamotrigine, a mood stabiliser, showing positive outcomes on ED symptoms when given in conjunction with DBT [1460].