Evaluation of the Efficacy of Serotoninergic Antidepressants in Bulimia Nervosa According to Brain Serotonin Profile Determined by Positron Emission Tomography With [18F] MPPF.

  • End date
    Mar 25, 2023
  • participants needed
  • sponsor
    Centre Hospitalier Universitaire de Saint Etienne
Updated on 26 January 2021
positron emission tomography
bulimia nervosa


Bulimia nervosa (BN) is a serious mental illness characterized by massive food crises followed by anxiety and compensatory behaviours (vomiting more often). Recent data show an increasing prevalence and a serious prognosis, due to excess mortality by suicide but also somatic complications.

Two types of treatments are validated : serotoninergic antidepressants (SSRI) and psychotherapy. Many clinical trials confirm the effectiveness of the SSRI. But many studies also emphasize the important proportion of non-responders to SSRI, few of them analyze the reasons for this non-answer.

To better understand the mode of action of SSRI, we should analyse the serotonergic activity in the central nervous system in bulimia. Recently, specific brain 5HT1A serotonin receptor ligands ([18F] MPPF or [11 C] WAY-100635), were used in positron emission tomography (PET) to characterize the serotonergic abnormalities of bulimic patients. The ligand [18F] MPPF has the feature to be sensitive to the level of endogenous serotonin.

A first pilot study using PET with [18F] MPPF realized between the University Hospital of Saint Etienne and Lyon CERMEP showed a diffuse increase of the binding potential of [18F] MPPF in bulimic patients, suggesting a decrease in serotonin activity.

The brain regions affected were angular gyrus, medial frontal cortex, left insula, cingulate gyrus and orbitofrontal gyrus. These areas are involved in major bulimic symptoms (impulse, taste, instinct, anxiety and satiety). However, we noticed an interindividual heterogeneity of cortical binding of [18F] MPPF.

In front of the heterogeneity in terms of efficacity of SSRI and brain serotoninergic activity, it seems necessary to continues investigations, to determine if there is a link between brain serotonin profile and responding to SSRI in bulimia nervosa.

Condition Bulimia, Bulimia Nervosa
Treatment positron emission tomography (PET), Antidepressants, Antidepressants
Clinical Study IdentifierNCT02359513
SponsorCentre Hospitalier Universitaire de Saint Etienne
Last Modified on26 January 2021


Yes No Not Sure

Inclusion Criteria

Patient affiliated or entitled to a social security scheme
Bulimic patients according to DSM-IV TR: minimum 2 bulimic crises (compulsive eating followed by compensatory behavior) / week for 3 weeks
Patients who signed informed consent to the study
BMI greater than or equal to 18.5 kg / m

Exclusion Criteria

Against-indication to the SSRI or fluoxetine
SSRI consumption in the previous three months
Other addiction (except tobacco, for reasons of feasibility)
Diagnosis of binge eating disorder or EDNOS (DSM-IV-TR)
Patients with heart failure
Against-indication for PET and / or MRI: pacemaker, intracerebral clips, prosthesis made of ferromagnetic material or claustrophobia
Subjects with suspected pregnancy or in the second half of their menstrual cycle in the absence of oral contraceptives; positive -HCG test before the exam
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