No drug exists that is specifically designed to treat bulimia nervosa, but 60mg of fluoxetine per day is FDA-approved as a treatment if psychotherapy is ineffectual. If fluoxetine fails to manage comorbid depressive or anxiety disorder, sertraline or escitalopram may be effective second options. Other SSRIs, in addition to topiramate, an antiepileptic, have demonstrated some efficacy, and stimulants may similarly be prescribed to treat continued binge-eating after purging cessation or to manage comorbid conditions. However, treatment with such drugs are considered off-label usages and are not FDA-approved. Certain psychiatric medications should also be avoided among bulimia nervosa patients. Bupropion should not be prescribed due to the increased risk of seizure. Similarly, citalopram should not be used due to increased risk of QT prolongation, and paroxetine should not be prescribed since it often leads to weight gain which may prompt purging relapses.