Is Wellbutrin (bupropion) used for the treatment of binge eating disorder?

Wellbutrin (Bupropion) for Binge Eating Disorder Treatment

Bupropion (Wellbutrin) is not a first-line treatment for binge eating disorder, but may be considered as an alternative medication option for adults with binge eating disorder who prefer medication or have not responded to psychotherapy alone. 1

First-Line Treatment Recommendations for Binge Eating Disorder

According to the 2023 American Psychiatric Association (APA) practice guidelines for eating disorders, the recommended treatment approach for binge eating disorder follows this hierarchy:

1. First-line treatment: Eating disorder-focused psychotherapy

   • Cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT) in either individual or group formats 1

2. Second-line medication options for adults who prefer medication or haven't responded to psychotherapy alone:

   • Antidepressant medications OR
   • Lisdexamfetamine (currently the only FDA-approved medication for BED) 1, 2

Bupropion's Role in Binge Eating Disorder

Bupropion has several characteristics relevant to binge eating disorder:

• It is the only antidepressant consistently shown to promote weight loss 1
• It works as a norepinephrine and dopamine reuptake inhibitor 1
• Clinical trials found it decreases body weight by suppressing appetite and reducing food cravings 1
• It is FDA-approved in combination with naltrexone (Contrave) for chronic weight management 1

However, research specifically on bupropion as a standalone treatment for BED shows mixed results:

• A randomized controlled trial found that while bupropion produced modest short-term weight loss in overweight/obese women with BED, it did not significantly improve binge eating frequency, food craving, or associated eating disorder features compared to placebo 3

Important Considerations and Contraindications

Cautions when considering bupropion:

• Seizure risk: Bupropion lowers seizure threshold 1
• Contraindicated in patients with:
  • Seizure disorders
  • Anorexia nervosa
  • Bulimia nervosa (due to increased seizure risk) 1, 4
  • Current use of MAOIs 1
  • Abrupt discontinuation of alcohol or sedatives 1

Side effects to monitor:

• Nausea, headache, constipation
• Insomnia, anxiety
• Dry mouth
• Increased blood pressure and heart rate 1

Treatment Algorithm for Binge Eating Disorder

1. Initial approach: Eating disorder-focused CBT or IPT (individual or group format)

2. If inadequate response to psychotherapy after 8-12 weeks or patient preference for medication:

   • First medication choice: Lisdexamfetamine (FDA-approved for BED)
   • Alternative medication options:
     • SSRIs (fluoxetine, sertraline, citalopram)
     • Topiramate (has evidence for BED but more side effects)
     • Bupropion (consider in patients with comorbid depression who would benefit from weight loss)

3. When specifically considering bupropion:

   • Best candidates: Patients with BED who also have:

     • Comorbid depression
     • Desire for weight loss
     • Food cravings as a predominant symptom
     • Comorbid tobacco use disorder (as bupropion is also used for smoking cessation)

   • Poor candidates: Patients with:

     • History of seizures or conditions predisposing to seizures
     • Eating disorders with purging behaviors (especially bulimia nervosa)
     • Uncontrolled hypertension
     • Substance withdrawal states

Conclusion

While bupropion is not a first-line treatment for binge eating disorder, it may be considered as an alternative medication option in specific patient populations, particularly those with comorbid depression who would benefit from its weight loss properties. However, clinicians should be aware of its limitations in treating the core symptoms of binge eating disorder and its contraindications in certain eating disorder populations.