Noradrenergic Modulation of Appetite and Impulse Control: Reboxetine in a Treatment-Resistant Case of Bulimia Nervosa

Abstract

Bulimia nervosa (BN) is a severe eating disorder often linked to impulsivity and emotional dysregulation. Despite selective serotonin reuptake inhibitors (SSRIs) being the primary pharmacological intervention, a portion of patients continues to exhibit treatment resistance. We present the case of a 17-year-old female diagnosed with BN who demonstrated enduring binge-purge behaviors and diminished motivation, despite undergoing treatment with fluoxetine and sertraline, both administered alongside low-dose aripiprazole. The introduction of reboxetine, a selective norepinephrine reuptake inhibitor (NRI), resulted in prompt and enduring decreases in binge eating, termination of laxative use, and significant enhancements in motivation, mood, and social functioning. The combination of reboxetine and aripiprazole was well tolerated, with no adverse effects reported. This case report highlights the potential clinical impact of noradrenergic modulation in adolescents with treatment-resistant BN. Reboxetine may ameliorate core symptoms by enhancing impulse control and motivational drive, and its adjunctive use with aripiprazole may further support emotional regulation. These findings suggest that reboxetine, particularly when combined with aripiprazole, could serve as a promising pharmacological alternative for similar cases, warranting further clinical investigation. Reboxetine, particularly when combined with aripiprazole, may serve as a promising pharmacological alternative for treatment-resistant BN, necessitating additional clinical research.

Cite this article as: Tayşi B, Tarak.ıoğlu MC. Noradrenergic Modulation of Appetite and İmpulse Control: Reboxetine in a Treatment-resistant Case of Bulimia Nervosa. Neuropsychiatr Invest. 2025, 63, 0046,

doi:10.5152/NeuropsychiatricInvest.2025.25046.