From the Guidelines
Treatment for binge eating disorder should primarily involve eating disorder-focused cognitive-behavioral therapy or interpersonal therapy, in either individual or group formats, as recommended by the American Psychiatric Association 1. This approach is considered the most effective way to address the psychological aspects of the disorder, helping patients identify triggers and develop healthier coping strategies.
- Cognitive-behavioral therapy (CBT) is a beneficial option, as it has been shown to be effective in reducing binge eating episodes and improving overall mental health.
- Interpersonal therapy is also a viable option, as it can help patients address underlying issues that may contribute to their binge eating behaviors. In addition to psychotherapy, medications such as antidepressants or lisdexamfetamine may be considered for adults with binge eating disorder who prefer medication or have not responded to psychotherapy alone 1.
- Lisdexamfetamine, in particular, has been FDA-approved specifically for the treatment of binge eating disorder and has been shown to be effective in reducing binge eating episodes. It is essential to note that treatment for binge eating disorder should be comprehensive, addressing both the psychological and physical aspects of the disorder.
- Nutritional counseling and support groups can also play a crucial role in establishing regular, balanced eating patterns and providing community understanding and accountability.
- Underlying issues such as depression, anxiety, or past trauma should also be addressed in the treatment plan, as they may contribute to the development and maintenance of binge eating behaviors.
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 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 with moderate to severe BED. The primary efficacy outcome for the two studies was defined as the change from baseline at Week 12 in the number of binge days per week. 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
Treatment Options for Binge Eating Disorder (BED):
- Lisdexamfetamine dimesylate capsules (50 or 70 mg/day) are effective in reducing the number of binge days per week in adults with moderate to severe BED 2.
- The treatment involves a 4-week dose-optimization period and an 8-week dose-maintenance period.
- Key secondary outcomes include a higher proportion of subjects rated improved on the CGI-I rating scale, higher proportion of subjects with 4-week binge cessation, and greater reduction in the Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating (Y-BOCS-BE) total score.
From the Research
Treatment Options for Binge Eating Disorder
The treatment options for binge eating disorder (BED) can be categorized into several types, including psychological, pharmacological, and combined treatments.
- Psychological Treatments: Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) have demonstrated efficacy in reducing binge eating and eating-disorder psychopathology 3, 4, 5. CBT guided self-help has also shown moderate support for the treatment of BED 5.
- Pharmacological Treatments: Lisdexamfetamine (LDX) is the only pharmacological agent approved by the FDA for the treatment of moderate-to-severe BED 3, 4, 6. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline and fluoxetine have also shown efficacy in reducing the frequency of binge eating 7.
- Combined Treatments: Combined CBT and LDX has been shown to be superior to individual treatments in reducing binge eating and eating-disorder psychopathology, and also resulted in significant weight loss 6.
Efficacy of Treatments
The efficacy of treatments for BED varies, with CBT and IPT showing durable benefits after treatment 3. LDX has been shown to be effective in reducing binge eating, but its effectiveness in producing weight loss is modest 4, 6. SSRIs have been shown to be effective in reducing the frequency of binge eating, but are ineffective in producing weight loss 7.
Future Research Directions
Future research should focus on identifying treatments for those who do not derive benefit from initial interventions, identifying additional pharmacological options, and testing agents with relevant mechanisms of action 3. Additionally, research should prioritize long-term follow-ups, standardized assessments, and the study of underrepresented populations 5.