Fluvoxamine in the treatment of binge-eating disorder: a multicenter placebo-controlled, double-blind trial.

OBJECTIVE: The purpose of this study was to assess the efficacy of fluvoxamine in the treatment of binge-eating disorder. Binge-eating disorder is a newly described eating disorder characterized by recurrent episodes of binge eating but without purging behaviors. Uncontrolled reports have suggested that serotonin selective reuptake inhibitors (SSRIs) may be effective in treating this disorder. METHOD: Eighty-five outpatients with a DSM-IV diagnosis of binge-eating disorder were randomly assigned to receive either fluvoxamine (N=42) or placebo (N=43) in a 9-week, parallel-group, double-blind, flexible dose (50-300 mg) study at three centers. The primary outcome measures were frequency of binge eating, expressed as log ([binges/week]+1), and Clinical Global Impression (CGI) scale ratings. Secondary measures included the level of response (based on the percentage change in frequency of binges), body mass index, and Hamilton Rating Scale for Depression score. Except for the level of response, the outcome measures were analyzed by random regression methods; the treatment-by-time interaction was the measure of treatment effect. RESULTS: Compared with placebo, fluvoxamine was associated with a significantly greater rate of reduction in the frequency of binges, rate of reduction in CGI severity scores, rate of increase in CGI improvement scores, level of response for patients who completed the 9-week study, and rate of reduction in body mass index. There was no significant difference between placebo and fluvoxamine groups in the rate of decrease in Hamilton depression scale scores. A significantly greater proportion of patients receiving fluvoxamine than those receiving placebo discontinued treatment because of an adverse medical event. CONCLUSIONS: In this placebo-controlled trial, fluvoxamine was found to be effective according to most outcome measures in the acute treatment of binge-eating disorder.

Fibromyalgia, psychiatric disorders, and assessment of the longterm outcome of eosinophilia-myalgia syndrome.

Fibromyalgia, medical disorders associated with fibromyalgia, and various psychiatric disorders may complicate the assessment of the longterm illnesses caused by the eosinophilia-myalgia syndrome (EMS). The effect of these conditions on the evaluation of outcome in EMS is shown by the use of clinical vignettes derived from a review of medical records of patients with EMS. These observations have implications for the clinical management of patients with a history of EMS and for interpretation of studies of the longterm outcome of EMS.

Antidepressant treatment of binge-eating disorder: research findings and clinical guidelines.

Binge-eating disorder, characterized by recurrent eating binges without purging, affects a large number of individuals, especially among participants in weight loss programs. Recent studies have suggested that antidepressants, particularly serotonin selective reuptake inhibitors, may be effective in the treatment of binge-eating disorder. This paper reviews the findings of these studies and offers clinical guidelines for the use of antidepressants in binge-eating disorder.

Acute cardiovascular effects of tranylcypromine: correlation with plasma drug, metabolite, norepinephrine, and MHPG levels.

BACKGROUND: Recent case reports, small series, and uncontrolled, unblinded studies have suggested that tranylcypromine may produce pressor reactions in some patients. However, the physiologic mechanism underlying this cardiovascular change is unknown. METHOD: The authors studied the acute cardiovascular effects of tranylcypromine in 13 patients and attempted to correlate these changes with plasma measures of parent drug, possible pressor metabolites, norepinephrine, and 3-methoxy-4-hydroxyphenylglycol. RESULTS: Significant elevations in supine blood pressure occurred after administration of tranylcypromine and correlated with tranylcypromine dose. Similar changes were not observed in standing blood pressure measurements. In fact, an orthostatic decrease in blood pressure and increase in heart rate were observed. Amphetamine-like metabolites were not found. CONCLUSIONS: The authors speculate on possible mechanisms underlying these opposite cardiovascular effects.

Trace nitrogenous species in urban atmospheres.

Recent results concerning the identification and measurement of nitrogenous air pollutants in the California South Coast Air Basin (CSCAB) are presented. In planning or evaluating studies of the human health effects of these pollutants, it is important to consider the entire range of species which may be present. We provide estimates of typical exposures to nitrogenous air pollutants during a single day oxidant event in the CSCAB.