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To the Editor: The controlled trial of fluoxetine vs placebo by Dr Walsh and colleagues¹ found a lack of benefit from fluoxetine in the treatment of patients with anorexia nervosa after regain of weight. Similar conclusions about both selective serotonin uptake reinhibitors and tricyclic antidepressants were reached in a Cochrane review.²

We believe that these results help in the understanding of eating disorders. Anorexia nervosa and bulimia nervosa seem to represent 2 distinct disorders, indicated by the responsiveness of bulimia nervosa to antidepressant drugs.³ Because major depressive disorder or obsessive-compulsive disorder were not explicit exclusion criteria in Walsh et al,¹ it would therefore be helpful to know what percentage of the patients in this study fulfilled standard criteria for either disorder as comorbidities to anorexia nervosa.

In addition, lack of efficacy of one class of drugs does not mean inefficacy of drug treatment for anorexia nervosa in general. Walsh et . . . [Full Text of this Article]

Michael Dettling, MD
michael.dettling@charite.de

Carolin Opgen-Rhein, MD; Arnim Quante; Ion Anghelescu, MD
Department of Psychiatry and Psychotherapy
Charité-University Medicine Berlin
Berlin, Germany

RELATED LETTER

Fluoxetine for Treatment of Anorexia Nervosa—Reply
B. Timothy Walsh, Christina A. Roberto, Allan S. Kaplan, and Wendi Rockert
JAMA. 2006;296(20):2440.
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