What medications are used to treat binge eating disorder?

Medications for Binge Eating Disorder

Lisdexamfetamine is the first-line FDA-approved medication for moderate to severe binge eating disorder, with topiramate, naltrexone/bupropion, and SSRIs (particularly fluoxetine) serving as effective alternatives depending on patient comorbidities and treatment goals. 1

First-Line Treatment Approach

• Psychotherapy, particularly cognitive-behavioral therapy (CBT) or interpersonal therapy, is recommended as the initial treatment for binge eating disorder (BED) 1
• Medications should be considered when patients prefer medication over psychotherapy, have not responded adequately to psychotherapy alone, or have comorbid obesity 2, 1

FDA-Approved Medication

• Lisdexamfetamine is the only FDA-approved medication specifically for moderate-to-severe binge eating disorder 1
• Dosing typically follows a titration protocol to minimize side effects 1
• It has been shown to significantly reduce binge eating episodes 3

Alternative Medication Options

Anticonvulsants

• Topiramate has substantial evidence for reducing binge eating behaviors and is often used as part of combination therapy (e.g., phentermine/topiramate ER) 1
• It can help reduce both binge eating frequency and body weight in BED associated with obesity 4

Combination Medications

• Naltrexone/Bupropion (Contrave) has evidence for weight management and is particularly useful for patients who describe food cravings or addictive eating behaviors 1
• This combination may benefit patients with comorbid depression or those trying to quit smoking 1

Antidepressants

• SSRIs have been studied extensively for BED treatment 4
• Fluoxetine (60 mg/day) has shown efficacy in reducing binge eating frequency and improving depression symptoms 5
• Sertraline has demonstrated significant reduction in binge eating frequency compared to placebo 5
• Fluoxetine is FDA-approved for bulimia nervosa but not specifically for BED 6

Medication Selection Algorithm

1. First consideration: Lisdexamfetamine for patients with moderate-to-severe BED, especially when weight management is a goal 1
2. For patients with comorbid depression: Consider fluoxetine (60 mg/day) or sertraline 5
3. For patients with significant food cravings or addictive eating patterns: Consider naltrexone/bupropion 1
4. For patients with obesity as primary concern: Consider topiramate or naltrexone/bupropion 1, 4

Efficacy Considerations

• SSRIs (fluoxetine, fluvoxamine, sertraline, citalopram) have been shown to modestly but significantly reduce binge eating frequency 4
• Fluoxetine has demonstrated the greatest reduction in depression scores among SSRIs used for BED 5
• Combined treatment (medication plus CBT) may be more effective than medication alone but not necessarily better than CBT alone 3, 7
• Most medications show modest efficacy for binge eating reduction but limited impact on weight loss 3, 5

Important Cautions and Monitoring

• Avoid weight gain-inducing medications such as mirtazapine and tricyclic antidepressants in BED patients with obesity 1
• Monitor for side effects and adjust dosing as needed for long-term treatment 1
• Most medication studies show short-term efficacy (8-16 weeks), with limited data on long-term outcomes 3, 4
• Weight loss benefits may diminish over time, even when binge eating improvements are maintained 7

Special Populations

• BED is associated with the development of obesity and affects individuals of all genders 2
• BED is particularly prevalent in women and may be exacerbated in those with polycystic ovary syndrome (PCOS) 8
• The lifetime prevalence of binge eating disorder in adolescent females is approximately 1.6% 8