This paper reviews the use of medication in the treatment of bulimia nervosa and of binge eating disorder. There is now compelling evidence from double blind, placebo-controlled studies that antidepressant medication is useful in the treatment of bulimia nervosa. What is less clear is which patients are most likely to benefit from antidepressant medications and how to best sequence the various therapeutic interventions available. The utility of antidepressant medications in bulimia nervosa has led to their evaluation in binge eating disorder. The limited information currently available suggests that antidepressant treatment may be associated with a reduction in binge frequency in obese patients with binge eating disorder, but does not lead to weight reduction. Additional studies of the use of medication in the treatment of binge eating disorder and of the role of pharmacotherapy in the treatment of bulimia nervosa are needed.