A comparison study of antidepressants and structured intensive group psychotherapy in the treatment of bulimia nervosa

Arch Gen Psychiatry. 1990 Feb;47(2):149-57. doi: 10.1001/archpsyc.1990.01810140049008.


Previous research on the treatment of outpatients with bulimia nervosa has focused on two treatment strategies: (1) drug therapy, primarily using tricyclic antidepressants, and (2) psychotherapy, often employing behavioral and cognitive behavioral techniques. We report here the short-term treatment outcome of a 12-week comparison trial of bulimic outpatients who were randomly assigned to one of four treatment cells: (1) imipramine hydrochloride treatment, (2) placebo treatment, (3) imipramine treatment combined with intensive group psychotherapy, and (4) placebo treatment combined with intensive group psychotherapy. All three active treatment cells resulted in significant reductions in target-eating behaviors and in a significant improvement in mood relative to placebo treatment. However, the results also suggested that the amount of improvement obtained with the intensive group psychotherapy component was superior to that obtained with antidepressant treatment alone. The addition of antidepressant treatment to the intensive group psychotherapy component did not significantly improve outcome over intensive group psychotherapy combined with placebo treatment in terms of eating behavior, but did result in more improvement in the symptoms of depression and anxiety.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Anorexia Nervosa / complications
  • Anorexia Nervosa / drug therapy
  • Anorexia Nervosa / therapy*
  • Anxiety / therapy
  • Behavior Therapy
  • Body Weight
  • Bulimia / complications
  • Bulimia / drug therapy
  • Bulimia / therapy*
  • Cognitive Behavioral Therapy
  • Combined Modality Therapy
  • Depression / therapy
  • Female
  • Humans
  • Imipramine / therapeutic use*
  • Outcome and Process Assessment, Health Care
  • Placebos
  • Psychotherapy, Group*
  • Randomized Controlled Trials as Topic


  • Placebos
  • Imipramine