Bulimia is an eating disorder in which individuals consume large amounts of food in short periods of time accompanied by an awareness that the eating pattern is abnormal. The episodes of binge eating may occur several times a day and are commonly terminated by self-induced vomiting or laxative abuse. While it gained little attention in the past, the prevalence of bulimia has recently been reported to be as high as 20 percent in college-age women. Many observers have described the presence of depressed mood among patients with bulimia. In preliminary studies we were impressed that many patients with bulimia had depressive syndromes which resembled """"""""atypical"""""""" or non-melancholic depression. Because of the efficacy of MAOI's in treating atypical depression, we treated 11 women with bulimia with MAOI's and found a positive response in 9. This proposal requests support for a randomized, double-blind trial of phenelzine in normal-weight patients with moderate to severe bulimia. In each of 3 years, 35 out-patients who meet modified DSM-III criteria for bulimia and who binge-eat at least 3 times weekly, will be recruited. Patients will be assessed by semi-structured interview, including the SADS, and a dexamethasone suppression test, and then begun on a 10 - 14 day placebo period. Patients who continue to binge-eat at least 3 times weekly will be randomly assigned to either phenelzine or placebo and treated for 8 weeks. We will compare the placebo and phenelzine treated groups on the Basis of binge frequency, attitudes toward eating and weight, and overall clinical improvement.

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New York State Psychiatric Institute
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Pauporte, J; Walsh, B T (2001) Serum cholesterol in bulimia nervosa. Int J Eat Disord 30:294-8
Goldfein, J A; Walsh, B T; Midlarsky, E (2000) Influence of shape and weight on self-evaluation in bulimia nervosa. Int J Eat Disord 27:435-45
Mayer, L E; Walsh, B T (1998) The use of selective serotonin reuptake inhibitors in eating disorders. J Clin Psychiatry 59 Suppl 15:28-34
Walsh, B T; Wilson, G T; Loeb, K L et al. (1997) Medication and psychotherapy in the treatment of bulimia nervosa. Am J Psychiatry 154:523-31
Loeb, K L; Pike, K M; Walsh, B T et al. (1994) Assessment of diagnostic features of bulimia nervosa: interview versus self-report format. Int J Eat Disord 16:75-81
Brody, M L; Walsh, B T; Devlin, M J (1994) Binge eating disorder: reliability and validity of a new diagnostic category. J Consult Clin Psychol 62:381-6
Walsh, B T; Hadigan, C M; Wong, L M (1992) Increased pulse and blood pressure associated with desipramine treatment of bulimia nervosa. J Clin Psychopharmacol 12:163-8
Walsh, B T; Hadigan, C M; Devlin, M J et al. (1991) Long-term outcome of antidepressant treatment for bulimia nervosa. Am J Psychiatry 148:1206-12
Walsh, B T; Wong, L M; Pesce, M A et al. (1990) Hyperamylasemia in bulimia nervosa. J Clin Psychiatry 51:373-7
Walsh, B T; Gladis, M; Roose, S P et al. (1988) Phenelzine vs placebo in 50 patients with bulimia. Arch Gen Psychiatry 45:471-5

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