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In the psychopharmacological treatment of bulimia nervosa (BN), antidepressants have a positive effect on mood and reduce the related preoccupation with body weight and the number of binge eating episodes. Research with antidepressants such as imipramine, desipramine, trazodone, phenelzine, amitriptyline and mianserin has been conducted to investigate their efficacy in the treatment of bulimia. A higher dose of the şuoxetine (60 mg/day) was shown to be effective in BN and has received FDA approval. Comorbidity of eating disorders with mood, anxiety, and substance use disorders is common. The presence of additional psychiatric disorders impairs compliance with treatment and makes treatment difficult by increasing severity and chronicity. The treatment of bulimia nervosa with şuoxetine is adversely affected by the presence of a mood disorder. High dose şuoxetine should be used for BN to be effective, but these high doses may increase the risk of a manic shift. When using şuoxetine in patients with a history of bipolar mood disorder (BiPMD) or a positive family history of BiPMD, clinicians need to be careful because of the possibility of a manic shift. There is not any developed algorithm for psychopharmacological treatment with comorbidity of BiPMD and BN; generally the use of agents that have a positive effect on both disorders is recommended, although such a medication is not available. Negative effects on weight gain or other negative interactions of mood stabilizers in BN, makes it difficult to use them. Like other antidepressants SSRIs may also cause a manic shift. The use of antidepressant doses of şuoxetine for mood and anxiety disorders are known to carry a risk for a manic or hypomanic shift. Hence, detailed examination of cases, where there is history of mood disorder or family history of mood disorder, is recommended. Using high dose şuoxetine in BN also increases the possibility of manic or hypomanic shifts. The use of şuoxetine 60 mg in a patient with BN caused a hypomanic shift, even though there was no history of bipolar disorder or a positive family history. A review of the treatment demonstrated that 60 mg of şuoxetine did not result in a significant decrease in symptoms and adequate treatment response. Retrospectively inadequate response to the treatment was associated with the presence of comorbid BiPMD.