A 20-year-old female with binge eating, laxative abuse, and periods of starvation—what is the best treatment option?

• A. Fluoxetine
• B. Gabapentin
• C. Amitriptyline
• D. Phenelzine

Answer: (A)

Bulimia nervosa is the pattern likely here, with recurrent binge eating and compensatory purging behaviors such as laxative abuse and fasting. The best pharmacologic option for bulimia is fluoxetine, an SSRI. It reduces the frequency of bingeing and purging episodes and helps stabilize mood and impulse control, with evidence from studies and FDA approval specifically for bulimia. It’s typically used at a higher dose (around 60 mg daily) and often works best when combined with psychotherapy like cognitive-behavioral therapy.

The other medications don’t have the same level of evidence for this disorder: gabapentin isn’t proven to reduce binge-purge cycles; amitriptyline has more adverse effects and less efficacy in bulimia; phenelzine carries significant dietary restrictions and safety concerns not suitable for someone with eating-disorder behaviors.