Hostname: page-component-745bb68f8f-s22k5 Total loading time: 0 Render date: 2025-01-27T15:25:47.713Z Has data issue: false hasContentIssue false
  • English
  • Français

A Placebo-Controlled Trial of d-Fenfluramine in Bulimia Nervosa

Published online by Cambridge University Press:  02 January 2018

Thomas A. Fahy ,
Ivan Eisler  and
Gerald F. M. Russell
Thomas A. Fahy*
Affiliation:
King's College Hospital and Institute of Psychiatry, De Crespigny Park, London SES 8AF
Ivan Eisler
Affiliation:
Department of Psychiatry, Institute of Psychiatry
Gerald F. M. Russell
Affiliation:
Institute of Psychiatry, and the Maudsley Hospital
*
∗Correspondence
Get access Rights & Permissions [Opens in a new window]

Abstract

d-Fenfluramine is a 5-HT agonist which decreases food intake and excessive carbohydrate intake in humans. A placebo-controlled trial of d-fenfluramine (45 mg/day) was conducted in 43 patients with bulimia nervosa. The patients entered an eight-week trial of medication during which they also received cognitive-behavioural therapy. Treatment response was assessed using food diaries to record eating behaviour, and self-rating questionnaires to measure psychopathology. The drug trial, and a follow-up assessment after a further eight weeks, were completed by 39 patients. Abnormal eating behaviour and psychopathology improved significantly in both the d-fenfluramine and placebo groups during the treatment trial. The study failed to show that the addition of d-fenfluramine affords an advantage over brief psychotherapy alone. Although d-fenfluramine is effective in suppressing the overeating, excessive snacking, and excessive carbohydrate consumption which are frequently found in overweight or obese patients, this study suggests that the drug is not an effective treatment for bulimia nervosa.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 162 , Issue 5 , May 1993 , pp. 597 - 603
Copyright
Copyright © Royal College of Psychiatrists, 1993 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.Google Scholar
Beck, A. T., Rush, A. J., Shaw, B. F., et al (1979) Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Borroni, E., Ceci, A., Grattini, S., et al (1983) Differences between d-fenfluramine and d-norfenfluramine in serotonin presynaptic mechanisms. Journal of Neurochemistry, 40, 891–893.Google Scholar
Diem, K. & Lentner, C. (1970) Geigy Scientific Tables. Basel: Documenta Geigy.Google Scholar
Fairburn, C. (1985) Cognitive behavioural treatment for bulimia. In Handbook of Psychotherapy for Anorexia Nervosa and Bulimia (eds Garner, D. M. & Garfinkel, P. E.), pp. 160–192. New York: Guilford Press.Google Scholar
Fairburn, C. & Begun, S. (1990) Studies of the epidemiology of bulimia nervosa. American Journal of Psychiatry, 147, 401–408.Google ScholarPubMed
Fairburn, C., Jones, R., Peveler, R. C., et al (1991) Three psychological treatments for bulimia nervosa. Archives of General Psychiatry, 48, 463–469.Google Scholar
Fichter, M. M., Leibl, K., Rief, W., et al (1991) Fluoxetine versus placebo: a double-blind study with bulimic inpatients undergoing intensive psychotherapy. Pharmacopsychiatry, 24, 1–7.Google Scholar
Fluoxetine Bulimia Nervosa Collaborative Study Group (1992) Fluoxetine in the treatment of bulimia nervosa. A multi-center, placebo-controlled, double-blind trial. Archives of General Psychiatry, 49, 139–147.Google Scholar
Freeman, C. P. L. & Hampson, M. (1987) Fluoxetine as a treatment for bulimia nervosa. International Journal of Obesity, 11, S171–177.Google Scholar
Freeman, C. P. L. & Hampson, M., Barry, F., Dunkeld-Thurnbull, J., et al (1988) A controlled trial of psychotherapy for bulimia nervosa. British Medical Journal, 296, 521–525.Google Scholar
Freeman, C. P. L. & Hampson, M., Barry, F., Dunkeld-Thurnbull, J., Davies, F. & Morris, J. (1990) A randomised controlled trial of fluoxetine for bulimia nervosa. Fourth international conference of eating disorders, New York.Google Scholar
Garattini, S., Mennini, T. & Samanin, R. (1989) Reduction of food intake by manipulation of central serotonin. British Journal of Psychiatry (suppl. 15), 41–51.Google Scholar
Garner, D. M. & Garfinkel, P. E. (1979) The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychological Medicine, 9, 273–279.Google Scholar
Goldbloom, D. S. & Garfinkel, P. E. (1990) The serotonin hypothesis of bulimia nervosa: theory and evidence. Canadian Journal of Psychiatry, 35, 741–744.Google Scholar
Goldbloom, D. S. & Garfinkel, P. E., Hicks, L. K. & Garfinkel, P. E. (1990) Platelet serotonin uptake in bulimia nervosa. Biological Psychiatry, 28, 644–647.Google Scholar
Henderson, M. & Freeman, C. P. L. (1987) A self-rating scale for bulimia. The BITE. British Journal of Psychiatry, 150, 18–24.Google Scholar
Hill, A. J. & Blundell, J. E. (1986) Model system for investigating the actions of anorectic drugs: effects of dfenfluramine on food intake, nutrient selection, food preferences, meal patterns, hunger and satiety in healthy human subjects. In Disorders of Eating Behaviour: A Psychoendo-neuroendocrine Approach (eds Ferrari, E. & Brambilla, F.), pp. 377–389. Oxford: Pergamon.Google Scholar
Hudson, J. I. & Pope, H. G. (1990) Psychopharmacological treatment of bulimia. In Bulimia Nervosa: Basic Research, Diagnosis and Therapy (ed. Fichter, M. M.), pp. 331–342. Chichester: Wiley.Google Scholar
Kaye, W. H., Gwirstman, H. E. & Brewerton, T. D. (1987) Serotonin regulation in bulimia. In Psychobiology of Bulimia (eds Hudson, J. I. & Pope, H. G.). Washington: APA.Google Scholar
Leibowitz, S. F. & Shor-Posner, G. (1986) Brain serotonin and eating behavior. Appetite, 7, S1–14.Google Scholar
Marazziti, D., Macchi, E., Rotondo, A., et al (1988) Involvement of serotonin system in bulimia nervosa. Life Sciences, 43, 2123–2126.Google Scholar
Mennini, T., Borroni, E., Samanin, R., et al (1981) Evidence of the existence of two different intraneuronal pools from which pharmacological agents can release serotonin. Neurochemistry International, 3, 289–294.CrossRefGoogle ScholarPubMed
Mitchell, J. E., Seim, H. C., Eckert, E. D., et al (1988) Preliminary results of a comparison treatment trial of bulimia nervosa. In The Psychology of Bulimia Nervosa (eds Pirke, K. M., Vandereycken, W. & Ploog, D.), pp. 152–157. Heidelberg: Springer.CrossRefGoogle Scholar
Norusis, M. J./SPSS Inc. (1988) SPSS/PC+advanced statistics V2.0. Chicago: SPSS.Google Scholar
Montgomery, S. A. & Åsberg, M. (1979) A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.CrossRefGoogle ScholarPubMed
Pinder, R. M., Brogden, R. N., Sawyer, P. R., et al (1975) Fenfluramine: a review of its pharmacological properties and therapeutic efficacy in obesity. Drugs, 10, 241–323.Google Scholar
Pope, H. G., Hudson, J. I., Jonas, J. M., et al (1985) Antidepressant drug therapy for bulimia: a two-year follow-up study. Journal of Clinical Psychopharmacology, 5, 320–327.Google Scholar
Robinson, P. H., Checkley, S. A. & Russell, G. F. M. (1985) Suppression of eating by fenfluramine in patients with bulimia nervosa. British Journal of Psychiatry, 146, 169–176.Google Scholar
Russell, G. F. M. (1979) Bulimia nervosa; an ominous variant of anorexia nervosa. Psychological Medicine, 9, 429–448.Google Scholar
Russell, G. F. M., Checkley, S. A., Feldman, J., et al (1988) A controlled trial of d-fenfluramine in bulimia nervosa. Clinical Neuropharmacology, 11, S146–159.Google Scholar
Silverstone, T., Smith, G. & Richards, R. (1987) A comparative evaluation of dextrofenfluramine and dl-fenfluramine on hunger, psychomotor function and side-effects in normal human subjects. In Body Weight Control: The Physiology, Clinical Treatment and Prevention of Obesity (eds Bender, A. E. & Brookes, L. J.), pp. 240–246. Edinburgh: Churchill Livingstone.Google Scholar
Tyrer, P. J. (1988) Personality Disorders: Diagnosis, Management and Course. London: Wright.Google Scholar
Wegman, E. J. (1972) Nonparametric probability density estimation. Technometrics, 14, 533–546.Google Scholar
Wurtman, J. J. & Wurtman, R. J. (1984) d-Fenfluramine selectively decreases carbohydrate but not protein intake in obese subjects. Journal of Obesity, 8, S79–84.Google Scholar
Wurtman, J. J. & Wurtman, R. J. & Mark, S. (1985) d-Fenfluramine selectively suppresses carbohydrate snacking by obese subjects. International Journal of Eating Disorders, 4, 89–99.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.