A 22-year-old woman with Bulimia Nervosa (BN) is started on fluoxetine. The FDA-approved dose of fluoxetine for bulimia nervosa is:

• A 20 mg/day (standard antidepressant dose)
• B 40 mg/day
• C 80 mg/day
• D 60 mg/day ✓

Explanation

Fluoxetine is the only FDA-approved medication for Bulimia Nervosa, at a dose of 60 mg/day — three times the standard antidepressant dose of 20 mg/day. At this higher dose, fluoxetine significantly reduces binge-purge frequency. For Major Depressive Disorder the usual dose is 20–40 mg/day; for OCD it is 40–80 mg/day. The higher dose for BN reflects the different serotonergic requirements in hypothalamic satiety regulation pathways.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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