From the Guidelines
Fluoxetine is the recommended selective serotonin reuptake inhibitor (SSRI) for treating binge eating disorder, as suggested by the American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1. When treating binge eating disorder with an SSRI, the following key points should be considered:
- Fluoxetine is typically started at a dose of 20mg daily and can be increased to 60mg daily if needed, as seen in the treatment of bulimia nervosa where 60 mg fluoxetine daily is prescribed 1.
- Treatment duration should be at least 8-12 weeks to properly assess effectiveness.
- Other SSRIs like sertraline, citalopram, and escitalopram may also be effective alternatives if fluoxetine isn't tolerated.
- Common side effects include nausea, headache, insomnia, and sexual dysfunction, which often improve after the first few weeks.
- For best results, medication should be combined with cognitive behavioral therapy or other psychological treatments specifically targeting binge eating patterns, as recommended by the APA guideline for binge-eating disorder treatment 1.
- Patients should be aware that full benefits may take 4-6 weeks to develop, and medication should never be stopped abruptly but rather tapered gradually under medical supervision. It's essential to note that while the guideline suggests either an antidepressant medication or lisdexamfetamine for adults with binge-eating disorder who prefer medication or have not responded to psychotherapy alone, fluoxetine is the most well-established SSRI for this condition, based on its recommendation for bulimia nervosa treatment 1.
From the FDA Drug Label
In US placebo–controlled clinical trials for bulimia nervosa, insomnia was reported in 33% of patients treated with Prozac 60 mg, and 13% of patients treated with placebo Anxiety and nervousness were reported, respectively, in 15% and 11% of patients treated with Prozac 60 mg and in 9% and 5% of patients treated with placebo Patients treated with Prozac 60 mg on average lost 0.45 kg compared with a gain of 0. 16 kg by patients treated with placebo in the 16–week double–blind trial.
The SSRI used for binge eating disorder is not explicitly mentioned in the provided text, but fluoxetine (Prozac) is used for bulimia nervosa, which is a related condition. However, the FDA drug label does mention the use of fluoxetine for bulimia nervosa, which may be relevant to binge eating disorder, but it does not directly answer the question. Since binge eating disorder is not directly mentioned, the answer should be: The FDA drug label does not answer the question.
From the Research
Selective Serotonin Reuptake Inhibitors (SSRIs) for Binge Eating Disorder
- Fluoxetine is a commonly used SSRI for the treatment of binge eating disorder, as shown in studies 2, 3, 4, 5, 6.
- According to a network meta-analysis, fluoxetine was found to be the most effective SSRI in reducing the frequency of binge eating, and it also showed the greatest reduction in Hamilton Rating Scale for Depression (HAMD) score 3.
- A randomized, double-blind, placebo-controlled study found that fluoxetine, alone or in combination with cognitive behavioral therapy (CBT), was effective in reducing binge eating episodes, but it was not superior to placebo in terms of remission rates 2.
- Another study found that fluoxetine was safe and effective in patients with bulimia nervosa, a related eating disorder, for up to 16 weeks 4.
- A one-year follow-up study found that CBT, alone or in combination with fluoxetine or fluvoxamine, was effective in reducing binge eating episodes and improving eating attitudes and behaviors, but the addition of fluoxetine to CBT did not provide any clear advantage 5.
- A randomized, double-blind trial comparing sertraline and fluoxetine found that both treatments were effective in reducing binge eating frequency and weight loss over a period of 24 weeks, with no significant differences between the two treatments 6.