Great question — let’s split it by condition:
Bulimia Nervosa
- FDA-approved antidepressant:
- Fluoxetine (Prozac)
- In 1994, the FDA approved fluoxetine for the treatment of bulimia nervosa.
- Effective dose: 60 mg/day (higher than the typical 20 mg/day used for depression).
- Evidence: RCTs showed fluoxetine reduced binge-eating and purging frequency, improved mood, and supported remission.
- Other antidepressants:
- Sertraline, citalopram, venlafaxine, etc. have shown some benefit in studies, but none are FDA-approved for bulimia.
Trichotillomania (Hair-Pulling Disorder)
- FDA-approved antidepressants:
- None.
- What has been studied:
- SSRIs (fluoxetine, sertraline, escitalopram) — mixed or weak results.
- Clomipramine (a tricyclic antidepressant with strong serotonergic effects) showed some efficacy in early small studies, but it is not FDA-approved for trichotillomania.
- Current guidelines consider medications off-label, with behavioral therapy (habit reversal training, CBT) as the first-line treatment.
✅ Summary
- Bulimia nervosa: Fluoxetine (Prozac) is the only FDA-approved antidepressant.
- Trichotillomania: No antidepressants FDA-approved (treatments are off-label; psychotherapy is first-line).
Would you like me to also give you a table of off-label pharmacologic options for trichotillomania (SSRIs, clomipramine, NAC, olanzapine, etc.), with evidence levels, so you can see what’s actually tried in practice despite lack of FDA approval?
