Can Wellbutrin (bupropion) be used to treat binge eating disorder?

Wellbutrin (Bupropion) for Binge Eating Disorder

Wellbutrin (bupropion) is not a first-line treatment for binge eating disorder and is not FDA-approved for this indication, though it may be considered as part of combination therapy in specific cases when patients have not responded to first-line treatments.

Evidence-Based Treatment Approach for Binge Eating Disorder

First-Line Treatments

According to the 2023 American Psychiatric Association (APA) practice guidelines for eating disorders, the recommended treatments for binge eating disorder are:

1. Psychotherapy: Eating disorder-focused cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT), in either individual or group formats 1

2. Medication options (for those who prefer medication or have not responded to psychotherapy alone):

   • Lisdexamfetamine (FDA-approved specifically for BED)
   • Antidepressants (various classes) 1

Role of Bupropion (Wellbutrin)

Bupropion is primarily mentioned in the literature as part of a combination therapy (bupropion/naltrexone SR) that was FDA-approved in 2014 for chronic weight management 1. This combination works by:

• Activating POMC neurons in the arcuate nucleus
• Causing release of alpha-melanocyte–stimulating hormone
• Affecting hypothalamic areas involved in feeding and weight control

However, this combination is approved for weight management, not specifically for binge eating disorder.

Treatment Algorithm for Binge Eating Disorder

1. Initial approach: Eating disorder-focused cognitive-behavioral therapy or interpersonal therapy 1

2. For patients who prefer medication or don't respond to psychotherapy:

   • First choice: Lisdexamfetamine (FDA-approved for BED) 2
   • Alternative: Topiramate (strong evidence but not FDA-approved for BED) 2

3. For patients with specific comorbidities:

   • With depression/anxiety: Consider SSRIs (citalopram, fluoxetine, sertraline) 2
   • With ADHD: Lisdexamfetamine may be particularly beneficial 2
   • With obesity: Consider liraglutide, semaglutide, or bupropion/naltrexone combination 2
   • With migraines: Consider topiramate or phentermine-topiramate ER 1

Important Clinical Considerations

• Monitoring requirements: Regular assessment of vital signs, particularly with stimulant medications or medications containing phentermine
• Contraindications:
  • Avoid stimulants in patients with uncontrolled hypertension, cardiovascular disease, or history of substance abuse
  • Avoid bupropion in patients with seizure disorders 1
  • Bupropion/naltrexone should not be used with opioid medications 1

Efficacy and Safety Considerations

The evidence for bupropion alone in BED is limited. When considering pharmacotherapy for BED:

• Lisdexamfetamine has the strongest evidence and is the only FDA-approved medication for BED 2
• Topiramate has shown efficacy but has more side effects 2
• Bupropion may be considered as part of the bupropion/naltrexone combination when weight management is also a goal 1

Common Pitfalls to Avoid

1. Using medications without concurrent psychotherapy: Psychotherapy remains the foundation of BED treatment

2. Focusing solely on weight loss: The primary goal should be reducing binge eating episodes and improving eating disorder psychopathology

3. Overlooking comorbidities: BED frequently co-occurs with mood disorders, anxiety disorders, ADHD, and substance use disorders, which may influence medication selection 2

4. Inadequate monitoring: Regular follow-up is essential to assess both efficacy and potential side effects of medications

In conclusion, while Wellbutrin (bupropion) is not a first-line treatment for binge eating disorder, it may be considered as part of combination therapy (particularly with naltrexone) in patients who have not responded to first-line treatments and when weight management is also a treatment goal.