Emerging treatments
Stepped care
In a randomized controlled trial, stepped care was found to be more effective than cognitive behavioral therapy (CBT) alone. In the stepped care approach, treatment was initiated with manualized 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 individualized approach.[111]
Topiramate
At least two randomized 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.[86]
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 behavioral therapy plus dialectical behavioral therapy
Dialectical behavioral therapy added to CBT may benefit eating-disorder patients who have borderline personality disorder.[115]
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