From the Research
Treating binge eating disorder in patients with epilepsy requires a careful approach that prioritizes both conditions, and I strongly recommend a combination of psychotherapy, specifically cognitive-behavioral therapy (CBT), as the first-line treatment, along with careful medication management, as evidenced by the most recent and highest quality study 1. When considering medication, it's essential to choose options that have minimal impact on seizure threshold.
- Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, which has been shown to be effective in reducing binge eating episodes 2, can be considered, starting at 20mg daily and potentially increasing to 60mg if needed.
- Topiramate, an anticonvulsant that may offer dual benefits for some patients by helping control both epilepsy and reducing binge eating behaviors, can be started at 25mg daily and gradually increased to 100-200mg daily in divided doses. Key aspects of treatment include:
- Regular monitoring of seizure frequency, medication levels, and eating behaviors
- Nutritional counseling to establish regular eating patterns
- Avoiding medications that can lower seizure threshold, such as bupropion and stimulants The goal is to address the psychological aspects of binge eating while ensuring epilepsy management remains stable and uncompromised, ultimately improving the patient's quality of life and reducing morbidity and mortality risks, as highlighted in recent reviews 3, 1.