Treatment with the antidepressant Zoloft may help women with bulimia curb their disordered eating behavior, preliminary research suggests.

The study of 18 women who took the drug for eight weeks found that after treatment, most had fallen below the threshold for “probable” bulimia on a standard questionnaire. And many were able to stop the cycles of binging and purging that mark the disorder.
The study, published in the International Journal of Eating Disorders, received partial funding from Zoloft maker Pfizer, Inc.

People with bulimia, most often young women, go through repeated episodes of binge-eating followed by purging, through vomiting or abuse of laxatives; some fast or excessively exercise to counter the binge.

Treatment typically involves counseling to address the distorted body image and other destructive thoughts and feelings that underlie the disorder. The antidepressant Prozac, which was approved in the U.S. in 1996 to treat bulimia, is another treatment option.

Like that drug, Zoloft - known generically as sertraline - is a selective serotonin reuptake inhibitor, or SSRI, but it has not received much attention as a potential bulimia therapy, according to the authors of the new study.

They found that after eight weeks on Zoloft, only two of the 14 women who completed the study remained above the threshold for probable bulimia, as did the four women who dropped out before completing treatment. Half of those who finished the study had stopped binging and purging by the end.

The most common side effects of the drug were diarrhea, headache, jitteriness and nausea.

Despite the drop in symptoms, the study does not prove Zoloft was effective for these patients because there was no comparison group that got a placebo, or inactive treatment.

All of the women knew they were receiving the antidepressant, so the improvement in their symptoms may have been the result of their expectations that they would get better, lead study author Dr. Denise M. Sloan told AMN Health.

What’s needed now is a “double-blind” placebo-controlled study where neither the patients nor the researchers know who’s getting the drug and who’s on the placebo, said Sloan, a professor of psychology at Temple University in Philadelphia.

Although Zoloft works in a similar manner as Prozac - acting on the brain chemical serotonin - the various SSRI drugs are not identical and may not have the same effects against bulimia, according to the researchers.

Sloan said there is reason to believe that some SSRIs might work better than others, because the compounds have different molecular structures that may act on the central nervous system in different ways.

Exactly why SSRI antidepressants are effective for some bulimics is unclear. Depression often goes hand-in-hand with the eating disorder, and women in the current study saw an improvement in depression symptoms. However, Sloan said it does not appear that SSRIs help simply by relieving bulimia patients’ depression.

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SOURCE: International Journal of Eating Disorders, July 2004.