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. 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. 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). 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.
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Authors | Dawson W Hedges, Frederick W Reimherr, Scott P Hoopes, Norman R Rosenthal, Marc Kamin, Rezaul Karim, Julie A Capece |
Journal | The Journal of clinical psychiatry
(J Clin Psychiatry)
Vol. 64
Issue 12
Pg. 1449-54
(Dec 2003)
ISSN: 0160-6689 [Print] United States |
PMID | 14728106
(Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anticonvulsants
- Topiramate
- Fructose
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Topics |
- Adult
- Anticonvulsants
(adverse effects, therapeutic use)
- Body Image
- Bulimia
(drug therapy, psychology)
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Administration Schedule
- Feeding Behavior
(drug effects)
- Female
- Fructose
(adverse effects, analogs & derivatives, therapeutic use)
- Humans
- Male
- Personality Inventory
- Self Concept
- Topiramate
- Treatment Outcome
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