Imipramine and diet counseling with psychological support in the treatment of obese binge eaters: A randomized, placebo-controlled double-blind study

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Abstract
Objective This study with 31 obese binge eaters (body mass index [BMI] 39.5 ± 8.6 kg/m2 [SD]) was designed to assess whether diet counseling with psychological support and imipramine or placebo has an effect on the frequency of binge eating, body weight, and depression during an 8‐week treatment phase. This was followed by an open medication‐free phase of 6 months of continuous diet counseling with psychological support. Methods Randomized double‐blind placebo‐controlled study of 8 weeks followed by an open phase of 6 months. Patients were evaluated in medical visits by a semistructured videotaped interview, psychometric questionnaires, and hematochemical parameters. Results From Week 0 to 8, a significant reduction in binge frequency occurred in both treatment conditions (7.1 ± 4.1 to 2.8 ± 3.0 binges per week [imipramine] vs. 7.1 ± 4.1 to 5.4 ± 5.1 [placebo], p < .01). Patients on imipramine lost −2.2 ± 1.8 kg compared to placebo‐treated subjects (+0.2 ± 3.3 kg, p < .001). On follow‐up, only the patients initially treated with imipramine continued to lose weight (−5.1 ± 2.8 kg [imipramine] vs. 2.2 ± 6.8 kg [placebo], p < .001 [differences to Week 0]). While both treatment conditions were associated with significant improvements on a rater's measure of depressive symptoms (Hamilton Depression Scale) at Week 8, only the patients treated with imipramine still showed a significant improvement at Week 32. Scores on the Self Depression Rating Scale did not show a group difference but a significant reduction at Weeks 8 and 32, compared to baseline. Discussion These results suggest that adding low‐dose imipramine to diet counseling with psychological support helps patients losing weight even for at least 6 months off medication. The effect might include a psychological priming of weight loss during the double‐blind phase that continues at least for half a year after stopping the drug. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 26: 231–244, 1999.