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Treatment of bulimia nervosa with topiramate in a randomized, double-blind, placebo-controlled trial, part 2: improvement in psychiatric measures.
- Source :
-
The Journal of clinical psychiatry [J Clin Psychiatry] 2003 Dec; Vol. 64 (12), pp. 1449-54. - Publication Year :
- 2003
-
Abstract
- Background: We conducted a 10-week, randomized, double-blind, placebo-controlled trial to examine the efficacy of topiramate in the treatment of bulimia nervosa. Primary efficacy analyses showed that topiramate treatment significantly reduced days on which patients binged and/or purged. This article describes further analyses investigating topiramate's effect on psychological symptoms associated with disordered eating.<br />Method: Patients with DSM-IV bulimia nervosa were randomly assigned to receive topiramate (N = 35) or placebo (N = 34) for 10 weeks. Topiramate treatment was started at 25 mg/day and titrated by 25 to 50 mg/week to a maximum of 400 mg/day. Secondary psychiatric endpoints, including the Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Rating Scale for Depression (HAM-D), and Patient Global Improvement (PGI) were assessed for change from baseline in the topiramate versus placebo group.<br />Results: Thirty-one patients receiving topiramate and 33 receiving placebo were included in the intent-to-treat analysis. Percent change from baseline on the EDI indicated significantly greater improvement in the topiramate group compared with the placebo group for subscales measuring bulimia/uncontrollable overeating (p =.005), body dissatisfaction (p =.007), and drive for thinness (p =.002). The EAT showed significant improvement in the topiramate group compared with the placebo group for the bulimia/food preoccupation (p =.019) and dieting (p =.031) subscales and the total score (p =.022). For the topiramate group, the reduction in mean HAM-A score was significantly greater (p =.046) than that in the placebo group, while reduction in HAM-D scores was greater in the topiramate group compared with the placebo group but did not reach statistical significance (p =.069). Significantly more patients treated with topiramate compared with placebo reported improvement on the PGI (p =.004).<br />Conclusion: Topiramate treatment improves multiple behavioral dimensions of bulimia nervosa. Binge and purge behaviors are reduced, and treatment is associated with improvements in self-esteem, eating attitudes, anxiety, and body image. These results support topiramate as a viable therapeutic option for the treatment of bulimia nervosa. Additional, longer-term multicenter trials are indicated.
- Subjects :
- Adult
Anticonvulsants adverse effects
Body Image
Bulimia psychology
Dose-Response Relationship, Drug
Double-Blind Method
Drug Administration Schedule
Feeding Behavior drug effects
Female
Fructose adverse effects
Humans
Male
Self Concept
Topiramate
Treatment Outcome
Anticonvulsants therapeutic use
Bulimia drug therapy
Fructose analogs & derivatives
Fructose therapeutic use
Personality Inventory
Subjects
Details
- Language :
- English
- ISSN :
- 0160-6689
- Volume :
- 64
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- The Journal of clinical psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 14728106
- Full Text :
- https://doi.org/10.4088/jcp.v64n1208