Emerging treatments
Stepped care
In a randomised controlled trial, stepped care was found to be more effective than cognitive behavioural therapy (CBT) alone. In the stepped care approach, treatment was initiated with manualised guided self-help CBT; continued with the addition of fluoxetine, if the response (based on an algorithm) was not sufficient; and then followed by a full course of CBT for patients who failed to achieve abstinence from binge eating and purging. Data from this trial suggest that treatment is enhanced with a more individualised approach.[111]
Topiramate
At least two randomised clinical trials have demonstrated that topiramate effectively decreases binge frequency. Tolerability, especially at higher doses, is limited by side effects. More studies with larger sample sizes and longer lengths of treatment are needed.[112] However, topiramate may trigger eating disorder symptoms in adolescents.[87]
Transcranial magnetic stimulation
Transcranial magnetic stimulation has shown benefit in some patients with bulimia nervosa. However, it should still be regarded as experimental.[113][114]
Cognitive behavioural therapy plus dialectical behavioural therapy
Dialectical behavioural therapy added to CBT may benefit eating-disorder patients who have borderline personality disorder.[115]
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