Is Wellbutrin (bupropion) effective for treating Binge Eating Disorder (BED)?

Bupropion Alone Is Not Recommended for Binge Eating Disorder

Bupropion monotherapy should not be used as a stand-alone treatment for binge eating disorder (BED), as it does not reduce binge eating frequency or eating disorder psychopathology, though it may produce modest weight loss. 1

Evidence Against Bupropion Monotherapy

The highest quality randomized controlled trial specifically examining bupropion for BED found no benefit for the core symptoms:

• In a placebo-controlled trial of 61 overweight women with BED, bupropion 300 mg/day for 8 weeks failed to reduce binge eating frequency, food cravings, or eating disorder features compared to placebo 1
• The only significant effect was modest weight loss (1.8% vs 0.6% BMI loss), which is clinically minimal 1
• The study authors explicitly concluded that bupropion is not supported as a stand-alone treatment for BED 1

Critical Safety Concern

Bupropion is contraindicated in patients with bulimia nervosa or anorexia nervosa due to seizure risk, and this caution extends to BED patients 2

• Case reports document severe abuse of bupropion by patients with eating disorders seeking appetite suppression, resulting in grand mal seizures at doses of 3,000-4,500 mg/day 3
• The medication's stimulant and anorexic effects create abuse potential specifically in eating disorder populations 3

Recommended Treatment Approach

First-Line Treatment

• Psychotherapy (cognitive-behavioral therapy or interpersonal therapy) is the initial recommended treatment for BED 4, 5

When Medication Is Indicated

Medications should be considered when patients prefer medication over psychotherapy or have not responded adequately to psychotherapy alone 4, 5

Lisdexamfetamine is the only FDA-approved medication specifically for moderate-to-severe BED and should be the first pharmacologic choice 4, 6, 7

Alternative Medication Options (in order of preference):

1. Topiramate - has substantial evidence for reducing binge eating behaviors 4, 5, 7

2. Naltrexone/Bupropion combination (Contrave) - useful for patients with food cravings, addictive eating patterns, comorbid depression, or those trying to quit smoking 2, 4, 5, 7

   • Note: This is the combination product, not bupropion alone
   • The naltrexone component antagonizes feedback loops that enhance bupropion's anorectic properties 2
   • Clinical experience suggests patients describing food cravings or addictive behaviors respond well 2

3. GLP-1 receptor agonists (liraglutide, semaglutide) - for patients with comorbid obesity 7

Medications to Avoid

Weight gain-inducing medications should be avoided in BED patients with obesity, including mirtazapine and tricyclic antidepressants 4, 5, 7

Clinical Bottom Line

While bupropion appears in combination products used for BED with obesity, the evidence does not support its use as monotherapy for treating binge eating disorder. The single high-quality trial demonstrated it fails to address the core pathology of BED. Choose lisdexamfetamine, topiramate, or naltrexone/bupropion combination instead, always after considering psychotherapy as first-line treatment.