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

ABSTRACT

OBJECTIVE: This study with 31 obese binge eaters (body mass index [BMI] 39.5+/-8.6 kg/m(2) [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.