Mechanisms of action in cognitive-behavioral and pharmacological interventions for obesity and bulimia nervosa

In the treatment of obesity, anorexiant medication appears to enhance restraint, presumably through altering internal cues, and facilitates weight loss with behavioral treatment. However, relapse occurs once medication is withdrawn. Antidepressants appear to work similarly, and initial evidence suggests the same limitations. Long-term combined pharmacologic and behavioral treatment, however, may be useful for some individuals not responding positively to behavioral treatment alone. In the treatment of bulimia nervosa, antidepressants appear to enhance restraint, whereas cognitive behavioral treatment decreases restraint. Thus, these modalities appear to be incompatible, and highly restrictive eating is not desirable for those of normal weight. However, for individuals not responding to cognitive-behavioral treatment, long-term pharmacologic treatment may be an alternative, perhaps combined with a more compatible psychological treatment.