How do you reassess for binge eating disorder in a client currently on Vyvanse (lisdexamfetamine) 20 mg?

Reassessment of Binge Eating Disorder in a Client on Vyvanse 20mg

For patients with binge eating disorder on Vyvanse 20mg, reassessment should focus on monitoring binge frequency, eating behaviors, and medication efficacy using standardized criteria, with potential dose adjustment if clinical response is inadequate. 1

Key Components of BED Reassessment

1. Evaluate Binge Eating Behaviors

• Assess current frequency of binge eating episodes (compared to baseline)
  • A binge is defined as eating a larger amount of food within a 2-hour period compared to peers with a perceived lack of control 2
  • Document if episodes occur at least once weekly (diagnostic threshold) 2
• Evaluate associated features of binges:
  • Eating faster than normal
  • Eating until uncomfortably full
  • Eating large amounts when not physically hungry
  • Eating alone due to embarrassment
  • Feeling distressed, guilty, or depressed after eating 2

2. Medication Efficacy Assessment

• Vyvanse (lisdexamfetamine) is the only FDA-approved medication for BED 3
• Current dose (20mg) may be subtherapeutic for many patients
  • The most recent research indicates higher doses may be more effective 4
• Document changes in:
  • Binge frequency (primary outcome)
  • Emotional distress related to binging
  • Overall eating disorder psychopathology 4

3. Weight and Physical Assessment

• Measure current weight, BMI, and waist circumference
  • Compare to baseline measurements
  • While weight loss is not the primary goal of BED treatment, it may occur with effective treatment 4
• Monitor vital signs, particularly heart rate and blood pressure
  • Stimulant medications can affect cardiovascular function 1

4. Laboratory Assessment

• Consider targeted laboratory testing based on clinical presentation:
  • Complete metabolic panel
  • Electrolytes (particularly if purging behaviors are present)
  • Other tests as clinically indicated 1

Treatment Adjustment Algorithm

If Inadequate Response to Current Dose:

1. Consider dose adjustment

   • Recent research shows combined CBT and lisdexamfetamine produces the highest remission rates (70.2%) 4
   • Higher doses of Vyvanse may be more effective than 20mg for BED symptoms

2. Evaluate for adjunctive treatments

   • Cognitive-behavioral therapy specifically targeting BED is strongly recommended 1
   • For patients with comorbid depression or anxiety, consider addressing these conditions 1

If Side Effects are Problematic:

• Common side effects include dry mouth, insomnia, and cardiovascular changes
• Balance efficacy against tolerability
• Consider alternative treatments if side effects are intolerable:
  • Other medication options include SSRIs (fluoxetine, sertraline) 5, 3
  • Venlafaxine has shown promise in preliminary studies 6

Common Pitfalls in Reassessment

• Focusing solely on weight rather than binge behaviors: The primary goal is reduction in binge eating episodes, not weight loss 1
• Inadequate dose optimization: 20mg may be insufficient; therapeutic doses in studies are often higher 4
• Missing comorbid conditions: Depression, anxiety, and other eating disorders frequently co-occur with BED 1
• Failure to use standardized criteria: Use DSM-5 criteria to ensure consistent assessment 2
• Not distinguishing between different eating disorders: BED differs from bulimia nervosa in that compensatory behaviors are absent 2

By systematically reassessing these key domains, clinicians can effectively monitor treatment response and make appropriate adjustments to optimize outcomes for patients with binge eating disorder on Vyvanse.