What is the most effective pharmacological treatment for food addiction, also known as binge eating disorder (BED)?

From the Guidelines

The most effective treatment for food addiction involves a comprehensive approach including therapy, lifestyle changes, and sometimes medications like lisdexamfetamine, as recommended by the American Psychiatric Association for binge-eating disorder 1. When considering medication for food addiction, it's essential to note that there is no single "best" medication specifically approved for this condition. Treatment typically involves addressing underlying issues such as binge-eating disorder, bulimia nervosa, or anorexia nervosa.

• For binge-eating disorder, the American Psychiatric Association recommends eating disorder-focused cognitive-behavioral therapy or interpersonal therapy, and suggests medication like lisdexamfetamine or antidepressants for adults who prefer medication or have not responded to psychotherapy alone 1.
• Medications like selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, might be used if depression or anxiety contribute to disordered eating patterns, as recommended for bulimia nervosa 1. Key points to consider when prescribing medication for food addiction include:
• The importance of a comprehensive treatment plan that includes cognitive-behavioral therapy, nutritional counseling, and addressing psychological factors.
• The need for close medical supervision due to potential side effects and individual variability in response to medication.
• The individualized nature of treatment, which should address the biological, psychological, and social aspects of food addiction. In terms of specific medications, lisdexamfetamine is suggested for adults with binge-eating disorder who prefer medication or have not responded to psychotherapy alone 1, while SSRIs like fluoxetine may be used for bulimia nervosa or depression/anxiety-related disordered eating patterns 1.

From the FDA Drug Label

A phase 2 study evaluated the efficacy of lisdexamfetamine dimesylate capsules 30,50, and 70 mg/day compared to placebo in reducing the number of binge days/week in adults with at least moderate to severe BED The 50 and 70 mg/day doses were statistically superior to placebo on the primary endpoint The efficacy of lisdexamfetamine dimesylate capsules in the treatment of BED was demonstrated in two 12-week randomized, double-blind, multi-center, parallel-group, placebo-controlled, dose-optimization studies (Study 11 and Study 12) in adults aged 18 to 55 years Subjects from both studies on lisdexamfetamine dimesylate capsules had a statistically significantly greater reduction from baseline in mean number of binge days per week at Week 12

The best medication to prescribe for food addiction, specifically Binge Eating Disorder (BED), is lisdexamfetamine dimesylate capsules at doses of 50 or 70 mg/day 2.

• Key benefits include a statistically significant reduction in the number of binge days per week and improvement in secondary outcomes such as CGI-I rating scale and Y-BOCS-BE total score.
• Important considerations include the need for dose optimization and maintenance, as well as monitoring for potential side effects and relapse.

From the Research

Medication Options for Food Addiction

• Lisdexamfetamine is the only FDA-approved medication for the treatment of binge-eating disorder (BED) 3, 4, 5.
• Other medications that have shown efficacy in treating BED include topiramate, anti-anxiety, and antidepressant medications 5, 6.
• A combination of naltrexone and bupropion, as well as pexacerfont, have also shown potential in reducing food addiction symptoms 7.
• Dasotraline has been found to be effective in reducing binge-eating episodes and promoting remission 6.

Efficacy and Safety of Medications

• Lisdexamfetamine has been shown to be effective in reducing BED symptoms and body weight, but it also has a high odds of adverse events, including anxiety, insomnia, diarrhea, and headache 4, 6.
• Topiramate has been found to be effective in reducing binge-eating episodes and promoting remission, with high-certainty evidence 6.
• The efficacy and safety of other medications, such as dasotraline, need to be further studied with larger trials and validated scales 6.

Treatment Considerations

• The use of FDA-approved medications, such as lisdexamfetamine, should be preferred when treating BED 5.
• Other medications that have proven efficacy in comorbid conditions, such as anxiety or depression, can be used and may provide a benefit for BED 5.
• A systematic evaluation of the published clinical and preclinical evidence for efficacy of medications in treating BED is needed to guide clinical practice 4.