Stimulant Studies for Binge Eating Disorder Beyond Vyvanse
Yes, there are studies on other stimulants for binge eating disorder, but the evidence is limited and these medications lack FDA approval for this indication. While lisdexamfetamine (Vyvanse) remains the only FDA-approved stimulant for BED 1, research has examined other amphetamine-based stimulants and related compounds.
Evidence for Other Stimulants
Amphetamine-Based Stimulants
Recent preclinical research demonstrates that amphetamine compounds can suppress binge-like eating behavior 2. In animal models, various amphetamine formulations reduced binge-like intake of highly palatable foods, with effects mediated through dopamine receptor pathways. However, these findings have not translated into clinical trials for BED in humans.
The mechanism appears similar to lisdexamfetamine—both work through dopaminergic pathways to enhance impulse control and reduce reward-seeking behavior 3. Mixed amphetamine salts (Adderall) and dextroamphetamine have been studied primarily for ADHD 4, not BED specifically, though their pharmacological profile suggests potential efficacy.
Methylphenidate
No published studies have specifically evaluated methylphenidate for BED treatment 5, 6. While methylphenidate is well-established for ADHD 7, 4, its application to eating disorders remains unexplored in the literature.
Alternative Pharmacological Options with Evidence
Rather than other stimulants, the evidence supports considering these alternatives 8:
Medications Containing Topiramate or Bupropion
- Topiramate shows comparable efficacy to lisdexamfetamine for reducing binge frequency (MD -1.63 vs -1.61 binge days/week) and produces the greatest weight loss (-5.5 kg) 9
- Naltrexone/bupropion combination demonstrates modest weight effects but lacks clear efficacy for binge reduction 9
- Bupropion alone suppresses binge-like eating in preclinical models 2
The 2016 AACE/ACE guidelines explicitly recommend: "treatment with orlistat or approved medications containing topiramate or bupropion may be considered in conjunction with structured lifestyle therapy, cognitive behavioral therapy, and/or other psychologic interventions" 8.
Important Clinical Considerations
Lisdexamfetamine remains the only stimulant with robust RCT evidence demonstrating:
- Significant reduction in binge days (1.29-1.66 fewer days/week) 3
- Decreased obsessive-compulsive eating behaviors (6.16-point reduction on Y-BOCS-BE) 3
- Meaningful weight loss (average 4.6 kg) 9
- Tolerable safety profile with diarrhea as a notable side effect 3
The 2023 APA guidelines suggest that adults with BED who prefer medication or have not responded to psychotherapy alone be treated with either an antidepressant or lisdexamfetamine 10.
Critical Gap in Evidence
No published studies have examined systematic approaches to discontinuing lisdexamfetamine after treatment response, despite concerns about long-term use including hypertension, misuse potential, cost, and drug interactions 11. This represents a significant clinical challenge when considering any stimulant therapy for BED.
Contraindications for All Stimulants
Absolute contraindications that apply to any stimulant consideration for BED 4:
- Concomitant MAOI use (risk of hypertensive crisis)
- Active psychosis or schizophrenia
- Glaucoma
- Recent stimulant abuse or dependence (relative contraindication requiring careful monitoring)
Clinical Algorithm
For patients with moderate-to-severe BED:
- First-line: Structured behavioral therapy + CBT 8, 10
- If inadequate response or patient preference for medication: Lisdexamfetamine 50-70 mg/day 10, 1
- Alternative pharmacotherapy: Topiramate (comparable efficacy, greater weight loss) or medications containing bupropion 8, 9
- Other stimulants: Not recommended due to lack of evidence and absence of FDA approval for BED
The evidence does not support using other stimulants beyond lisdexamfetamine for BED treatment. While the pharmacological rationale exists, clinical trial data are absent, and guideline recommendations consistently specify lisdexamfetamine as the only stimulant option 10, 5, 6.