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Bulimia nervosa is associated with altered levels of neurotransmitters, or chemical messengers in the brain. This is particularly true of serotonin levels. It makes sense, then, that medications developed to improve the function of neurotransmitters might be useful in the treatment of eating disorders.
Several different categories of psychiatric medications have been shown to be beneficial, but the most widely studied are the SSRIs (Selective Serotonin Reuptake Inhibitors), the first and most famous of which is fluoxetine, or Prozac. Other SSRIs include sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalopram/escitalopram (Celexa/Lexapro). All raise the levels of serotonin available in parts of the brain.
The largest bulimia nervosa treatment trial in the world documented the benefits of high-dose fluoxetine. This led to approval of fluoxetine specifically for the treatment of bulimia nervosa. Treatment is recommended to begin and continue at a dose of 60 mg. (The dose of 20 mg commonly used for depression was no better than a placebo.) Bulimics benefit from fluoxetine regardless of whether they are depressed. Moreover, if fluoxetine is going to be helpful, the results will be apparent within 4 weeks. At least one study has shown this to be a successful initial approach when used by primary care providers.
The recommended fluoxetine dose for bulimia is 60 mg once a day. However, your healthcare provider may decide to prescribe a lower dose in certain situations, such as for elderly people or for people with liver problems.
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