What is the best medication for treating binge eating disorder?

From the Guidelines

The best medication for treating binge eating disorder is lisdexamfetamine, as recommended by the American Psychiatric Association 1.

Key Points to Consider

• Lisdexamfetamine is the only FDA-approved medication specifically for binge eating disorder, and it has been shown to be effective in reducing binge eating episodes.
• The American Psychiatric Association recommends that adults with binge-eating disorder who prefer medication or have not responded to psychotherapy alone be treated with either an antidepressant medication or lisdexamfetamine 1.
• It's essential to note that medication works best when combined with psychological treatments such as cognitive behavioral therapy (CBT) or interpersonal therapy, as recommended by the APA 1.

Medication Details

• The usual starting dose of lisdexamfetamine is 30mg once daily in the morning, which may be increased to 50mg or 70mg daily if needed.
• Treatment duration is typically long-term, as symptoms often return when medication is discontinued.
• Lisdexamfetamine works by regulating dopamine and norepinephrine in the brain, which helps control impulsive behaviors and reduce binge eating episodes.

Important Considerations

• Common side effects of lisdexamfetamine include insomnia, decreased appetite, anxiety, and increased heart rate.
• This medication is not appropriate for everyone, particularly those with heart conditions, and should only be taken under close medical supervision due to its stimulant properties and potential for dependence.
• Other medications, such as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, may also be used off-label to treat binge eating disorder, but lisdexamfetamine is currently the most recommended option 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

Lisdexamfetamine dimesylate is a medication that has been shown to be effective in treating binge eating disorder (BED). The recommended doses are 50 mg/day and 70 mg/day, as these doses were statistically superior to placebo in reducing the number of binge days per week. 2

• Key points:
  • Lisdexamfetamine dimesylate capsules have been evaluated in clinical trials for the treatment of BED
  • The 50 and 70 mg/day doses were effective in reducing binge days per week
  • The medication has been shown to be effective in adults aged 18 to 55 years with moderate to severe BED

From the Research

Medications for Binge Eating Disorder

The following medications have been studied for the treatment of binge eating disorder:

• Lisdexamfetamine: Approved by the FDA for the treatment of moderate to severe binge eating disorder in adults, lisdexamfetamine has been shown to significantly reduce binge eating days/week 3, 4, 5, 6.
• Selective serotonin reuptake inhibitors (SSRIs): Fluoxetine and sertraline have been found to be effective in reducing the frequency of binge eating, with fluoxetine showing the greatest reduction in Hamilton Rating Scale for Depression (HAMD) score 7.
• Topiramate: Has been shown to significantly reduce both binge eating and weight, although it is not FDA approved for the treatment of binge eating disorder 4, 6.

Efficacy and Acceptability

The efficacy and acceptability of these medications vary:

• Lisdexamfetamine: Generally well tolerated, with common side effects including dry mouth, headache, and insomnia 3.
• SSRIs: Well accepted, with a low dropout rate due to side effects 7.
• Topiramate: Can have significant side effects, but has been shown to be effective in reducing binge eating and weight 4, 6.

Treatment Considerations

When considering treatment for binge eating disorder, the following should be taken into account:

• FDA approval: Lisdexamfetamine is the only FDA approved medication for the treatment of moderate to severe binge eating disorder in adults 3, 4, 5, 6.
• Comorbid conditions: The presence of comorbid psychiatric conditions, such as anxiety or depression, may influence the choice of medication 4.
• Individual response: Patients may respond differently to different medications, and treatment should be tailored to the individual 7, 4, 5, 6.