Duloxetine's Effect on Binge Eating Disorder
Duloxetine (Cymbalta) shows promising efficacy for binge eating disorder, with evidence supporting its ability to reduce binge eating episodes and associated depressive symptoms in obese patients. 1
Mechanism of Action and Rationale
Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that inhibits the presynaptic reuptake of both serotonin and norepinephrine in the brain. This dual mechanism is particularly relevant for binge eating disorder because:
- SNRIs like duloxetine modulate both serotonergic and noradrenergic pathways involved in mood regulation and impulse control 2
- The noradrenergic component specifically helps with pain control and may address the emotional dysregulation component of binge eating 2
- Duloxetine's effects on both neurotransmitter systems may help address the comorbid depression and anxiety often seen with binge eating disorder 2, 3
Evidence for Efficacy
The most compelling evidence comes from a 12-week open trial with 45 obese patients with binge eating disorder (BED) or subthreshold BED:
- Significant reduction in number of binges per week
- Meaningful decreases in binge eating scale (BES) scores
- Improvements in depression scores
- Reductions in weight and BMI 1
This is supported by case report evidence showing complete remission of bingeing behaviors in a patient with previously refractory BED treated with duloxetine 4.
Clinical Considerations
When considering duloxetine for binge eating disorder:
- Starting dose is typically 30mg daily, titrated to 60-120mg daily as needed and tolerated 1
- Duloxetine appears particularly effective for patients with:
- Regular monitoring is essential for:
- Frequency of binge episodes
- Depression and anxiety symptoms
- Weight and vital signs
- Potential side effects 3
Side Effects and Precautions
Common side effects of duloxetine include:
- Diaphoresis, dry mouth
- Gastrointestinal symptoms (nausea, vomiting, abdominal discomfort)
- Dizziness, headache, tremor
- Sleep disturbances
- Decreased appetite 2
More serious but rare concerns include:
- Potential for increased blood pressure and pulse
- Risk of suicidal thinking (particularly in younger patients)
- Serotonin syndrome when combined with other serotonergic medications
- Hepatic concerns (discontinue if jaundice or liver dysfunction develops) 2
Alternative Medications for Binge Eating Disorder
If duloxetine is not suitable or effective, other evidence-based options include:
- Lisdexamfetamine - FDA-approved specifically for BED 3, 5
- Fluoxetine 60mg daily - recommended by the American Psychiatric Association for BED with comorbid depression and anxiety 3
- Topiramate - shown to be effective for BED 5
- Naltrexone/bupropion combination - may help patients who describe food cravings or addictive eating behaviors 2
Comprehensive Approach
While duloxetine shows promise for BED, optimal treatment typically involves:
- Combining medication with cognitive-behavioral therapy (CBT) specifically focused on eating disorders
- Addressing comorbid conditions like depression, anxiety, and ADHD
- Regular monitoring of binge frequency, weight, and psychological symptoms
- Focus on reducing binge eating episodes rather than solely on weight loss 3
In conclusion, duloxetine represents a valuable pharmacological option for binge eating disorder, particularly when comorbid depression or anxiety is present, with evidence supporting its efficacy in reducing binge frequency and improving associated symptoms.