Stimulant treatment of bulimia nervosa with and without attention-deficit disorder: Three case reports

FreeText:The patient noted the onset of bulimia in her early 20s. Binge eating was initially associated with depressive feelings related to family problems. She would binge on junk food up to twice a day and compensated with excessive exercise, food restriction, dieting, and laxative use. She began fluoxetine for depression at age 33 years, after the death of her brother, and was off and on it since then. Some initial improvement was noted in her bulimia with less food craving and some decrease in the frequency of binges, but soon she was binging again with her usual frequency. At age 39 y she was diagnosed with ADD and began treatment with Ritalin.; Indications:1 patient with attention deficit hyperactivity disorder and bulimia nervosa characterized by binge eating. Coexisting disease: depression.; Patients:One 42-year-old woman (outpatient).; TypeofStudy:A case of bulimia nervosa with attention deficit hyperactivity disorder (ADD) that was successfully treated by Ritalin was reported. Case report.; DosageDuration:10 mg bid (=20 mg daily), with doses increasing to 20 mg bid (=40 mg daily). Duration was at least 2 years.; Results:Within 3 weeks her binging ceased and craving for food diminished. Depressive symptoms and attention also improved. Over the next 2 years she stopped taking Ritalin on several occasions only to notice a return of bulimic symptoms. She experienced 2 or 3 brief and mild relapses while taking Ritalin over a 2-year treatment period but felt that control of her bulimia was much improved when Ritalin was added to her treatment regimen. She continued to exercise regularly but not excessively.; AdverseEffects:No adverse events were mentioned.; AuthorsConclusions:Further study including placebo-controlled trials in patients without comorbid ADD may clarify the role of stimulants in the treatment of bulimia nervosa.