What medications are used to treat binge eating disorder?

Medications for Binge Eating Disorder

For adults with binge eating disorder who prefer medication or have not responded to psychotherapy alone, either an antidepressant medication or lisdexamfetamine should be used as first-line pharmacological treatment. 1

First-Line Treatment Approach

• Psychotherapy is the recommended initial treatment for binge eating disorder (BED), specifically eating disorder-focused cognitive-behavioral therapy (CBT) or interpersonal therapy in either individual or group formats 1
• Medications should be considered when:
  • Patients prefer medication over psychotherapy 1
  • Patients have not responded adequately to psychotherapy alone 1
  • Comorbid conditions exist that may benefit from specific medications 2

Medication Options for BED

FDA-Approved Medications:

• Lisdexamfetamine (Vyvanse):
  • Only medication specifically FDA-approved for BED in some countries 2
  • Stimulant medication that reduces binge eating episodes 2
  • Particularly useful in patients with comorbid ADHD 2
  • Dosing typically follows titration protocol to minimize side effects 1

Off-Label Medications with Evidence:

• Antidepressants:

  • Fluoxetine (Prozac):
    • Effective for BED although not specifically FDA-approved for this indication 3, 4
    • FDA-approved for bulimia nervosa at 60mg daily dose 3
    • May help with comorbid depression and anxiety 5

• Topiramate:

  • Anticonvulsant with evidence for reducing binge eating behaviors 2, 6
  • Often used as part of combination therapy (e.g., phentermine/topiramate ER) 1
  • Mechanism thought to be mediated through modulation of gamma-aminobutyric acid receptors and glutamate antagonism 1

• Naltrexone/Bupropion (Contrave):

  • Combination medication with evidence for weight management 1
  • Particularly useful for patients who describe food cravings or addictive eating behaviors 1
  • May benefit patients with comorbid depression or those trying to quit smoking 1

Medication Selection Algorithm

1. Assess for comorbidities that may influence medication choice:

   • If ADHD is present → Consider lisdexamfetamine 2
   • If depression/anxiety is prominent → Consider SSRI (fluoxetine, citalopram, sertraline) 2, 6
   • If obesity is a significant concern → Consider lisdexamfetamine, topiramate, or naltrexone/bupropion 1
   • If food cravings/addictive eating patterns → Consider naltrexone/bupropion 1

2. Start with FDA-approved option when appropriate:

   • Lisdexamfetamine (if available and not contraindicated) 2

3. Monitor response at 12 weeks:

   • If inadequate response, consider switching to alternative medication 1
   • For partial response, consider combination therapy (medication + CBT) 5, 4

Important Considerations and Cautions

• Avoid weight gain-inducing medications in BED patients with obesity:

  • Certain atypical antipsychotics (olanzapine, clozapine)
  • Mirtazapine
  • Tricyclic antidepressants
  • Valproate 2

• Medication efficacy assessment:

  • Evaluate reduction in binge eating episodes 4
  • Monitor weight changes, though modest weight loss should not be the primary goal 4
  • Assess improvement in psychological features of BED 4

• Combination therapy considerations:

  • CBT combined with medication may be more effective than medication alone 5, 4
  • In studies, CBT + placebo showed better remission rates (73%) than fluoxetine alone (29%) 4

• Long-term treatment:

  • Periodically reevaluate the need for continued medication 3
  • Monitor for side effects and adjust dosing as needed 1
  • Consider maintenance therapy for patients with recurrent symptoms 7

Emerging Treatments

• GLP-1 receptor agonists (liraglutide, semaglutide) show promise for BED with comorbid obesity 2
• Novel compounds like tirzepatide and retatrutide (GIP/GLP-1/glucagon receptor agonists) may help reduce binge eating in individuals with obesity 2