Buspirone is NOT Recommended for Binge-Eating Disorder
Buspirone is not an evidence-based treatment for binge-eating disorder and should not be used for this indication. The 2023 APA guidelines make no mention of buspirone as a treatment option for BED, and it is not FDA-approved for this condition 1.
First-Line Treatment Approach
For binge-eating disorder without purging behaviors, the treatment algorithm is clear:
Start with eating disorder-focused cognitive-behavioral therapy (CBT) or interpersonal therapy, delivered in either individual or group formats 1. This is a strong recommendation (1C) from the 2023 APA guidelines.
When to Add Medication
If you prefer medication or have not responded to psychotherapy alone, use either an antidepressant (such as an SSRI) or lisdexamfetamine 1. This is a suggestion (2C), meaning there is moderate uncertainty but benefits still outweigh harms.
Specific Medication Options:
- Lisdexamfetamine: The only FDA-approved medication for BED 2, 3
- Antidepressants: SSRIs like fluoxetine, sertraline, or citalopam 2
- Topiramate: Off-label but has evidence for BED 2
Why Not Buspirone?
The evidence for buspirone in eating disorders is extremely limited:
Wrong disorder studied: The only relevant study examined buspirone in bulimia nervosa (which involves purging), not binge-eating disorder 4. This was a small, open-label trial from 2006 with only 22 patients receiving buspirone.
Not in guidelines: The comprehensive 2023 APA eating disorder guidelines do not mention buspirone as a treatment option for any eating disorder, including BED [1-1].
Not FDA-approved: Buspirone is approved only for generalized anxiety disorder 5. The FDA label contains no information about eating disorders.
Common Pitfalls to Avoid
Don't confuse bulimia nervosa with binge-eating disorder: Bulimia involves purging behaviors; BED does not. Your patient explicitly states they do not purge, confirming BED rather than bulimia.
Don't use medications without trying psychotherapy first: CBT and interpersonal therapy have stronger evidence and should be the initial approach.
Don't prescribe buspirone for BED based on its anxiolytic properties: While patients with BED may have comorbid anxiety, treating the anxiety does not address the core eating disorder pathology.
If Comorbid Anxiety Exists
If your patient has both BED and generalized anxiety disorder, treat each condition appropriately:
- For BED: CBT/interpersonal therapy ± lisdexamfetamine or an SSRI
- For anxiety: SSRIs (which would cover both conditions), buspirone, or other anxiolytics
In this scenario, an SSRI would be preferable to buspirone as it addresses both conditions with evidence-based treatment 2.