What is the recommended pharmacologic treatment for bulimia nervosa?

The recommended pharmacologic treatment for bulimia nervosa is high-dose fluoxetine. Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), has been shown to be effective in reducing the frequency of binge-eating and compensatory behaviors associated with bulimia nervosa. It can also help alleviate co-occurring symptoms of depression and anxiety that are often present in individuals with this disorder. Research supports its efficacy, particularly when administered at higher doses compared to those typically used for depression, making it a first-line pharmacological option for treating bulimia nervosa.

In contrast, other options like topiramate may have some effect on weight loss and reducing binge-eating in certain contexts, but they are not the first-line treatment specifically for bulimia nervosa. Similarly, olanzapine, an atypical antipsychotic, is not indicated for this eating disorder and may not address the specific symptoms effectively. Phentermine, primarily used for weight loss, does not target the underlying issues of bulimia nervosa and is not a recommended treatment for this condition. Thus, fluoxetine remains the preferred pharmacologic intervention due to its established benefits and supportive evidence in this context.