Remission of Bulimia Nervosa Observed During Administration of Liraglutide and Metformin: A Case Report

ABSTRACT Objective: Bulimia nervosa, an eating disorder characterized by recurrent binging and purging episodes, is frequently associated with depression. Conventional therapy with antidepressants and cognitive behavioral therapy has poor long-term success. Appetite-regulating gut hormones such as glucagon-like peptide 1 (GLP-1) may be implicated in the pathophysiology, and thus, GLP-1 receptor agonists may be an effective therapy. Methods: A 26-year-old patient with polycystic ovary syndrome (PCOS) on chronic metformin therapy, with reactive hypoglycemia, bulimia nervosa, and depression, unresponsive to antidepressants and psychotherapy, was given a trial of liraglutide 1.2 mg daily to control hunger and prolong satiety. Results: The patient reported a more prolonged sensation of satiety after meals and complete resolution of her bulimic behavior within 2 weeks of starting liraglutide. She remains 5 years later with absence of bulimic behavior. She has tried stopping metformin or liraglutide separately but notices recurrence of hunger and weight gain within 1 to 2 weeks. Her depression has cleared since bulimia is controlled and is no longer in need of psychotherapy or psychiatric medications. Conclusion: Bulimia nervosa and depression were completely controlled in this patient with underlying PCOS within 2 weeks of adding liraglutide to ongoing metformin therapy. GLP-1 deficiency may underlie some cases of bulimia. Bulimia may in some cases represent a metabolic rather than psychiatric disorder. In this patient, the combination of metformin and liraglutide was more effective at controlling hunger than either agent alone. Liraglutide should be further evaluated as medical therapy for bulimia nervosa, either alone or in combination with metformin. Abbreviations: BMI body mass index GLP-1 glucagon-like peptide 1 PCOS polycystic ovary syndrome