Agras W S
Psychopharmacol Bull. 1997;33(3):433-6.
The longer-term effects of antidepressant medication, with and without the addition of psychotherapy, for the treatment of bulimia nervosa and binge eating disorder are reviewed. The use of a single antidepressant agent results in recovery of about 25 percent of patients entering treatment; continued treatment is accompanied by relapse in about one-third of these patients. Substituting one or more antidepressants for the initial agent in patients who fail to improve or cannot tolerate side effects improves long-term maintenance. Adding cognitive-behavioral therapy (CBT) may prevent relapse once medication is discontinued, and the combination of CBT and antidepressant treatment is more effective than a single medication. There is also evidence that antidepressant treatment combined with CBT is more effective than placebo plus CBT. The problem of how to sequence medication and CBT has not been resolved, although a recent study demonstrating that pharmacotherapy is more cost-effective than CBT suggests that treatment might begin with medication.
本文综述了抗抑郁药物单独或联合心理治疗对神经性贪食症和暴饮暴食症的长期治疗效果。使用单一抗抑郁药治疗，约25%的患者可康复；持续治疗的患者中约三分之一会复发。对于治疗效果不佳或无法耐受副作用的患者，换用一种或多种抗抑郁药可改善长期疗效。加用认知行为疗法（CBT）可预防停药后的复发，且CBT与抗抑郁药联合治疗比单一用药更有效。也有证据表明，抗抑郁药联合CBT比安慰剂联合CBT更有效。尽管最近一项研究表明药物治疗比CBT更具成本效益，提示治疗可从药物开始，但药物治疗和CBT的先后顺序问题仍未解决。
