Aripiprazole (Abilify) is NOT Recommended for Binge Eating Disorder
Aripiprazole has no established role in the treatment of binge eating disorder and should not be used for this indication. The medication is not FDA-approved for binge eating disorder, is not mentioned in any eating disorder treatment guidelines, and lacks supporting evidence for efficacy in this condition 1, 2.
Evidence-Based Treatment Options for Binge Eating Disorder
First-Line Treatment: Psychotherapy
- Cognitive-behavioral therapy (CBT) is the primary recommended treatment for binge eating disorder, available in both individual and group formats 1, 2.
- Interpersonal therapy (IPT) serves as an equally effective alternative when CBT is unavailable or not preferred 1, 2.
- These psychotherapies should focus on normalizing eating patterns and addressing underlying psychological factors rather than weight loss as the primary goal 2, 3.
FDA-Approved Pharmacotherapy
- Lisdexamfetamine (Vyvanse) is the only FDA-approved medication for moderate-to-severe binge eating disorder 2, 4, 5, 6.
- This stimulant prodrug has robust effect sizes for response, remission, and relapse prevention compared to placebo 6.
- Lisdexamfetamine should be considered either initially or when there is minimal response to psychotherapy alone 1, 2.
Off-Label Medication Options
- Antidepressants, particularly SSRIs (fluoxetine 60mg daily, sertraline, citalopram), can be used as alternative pharmacological options 1, 7, 8.
- Topiramate (an anticonvulsant) has demonstrated efficacy in reducing binge eating frequency and body weight, though it is not FDA-approved for this indication 7, 5, 8.
Critical Implementation Considerations
Comprehensive Assessment Required
- Quantify eating behaviors including frequency and patterns of binge episodes 1, 2.
- Identify co-occurring psychiatric disorders, which are present in 79% of patients with binge eating disorder 2.
- Perform physical examination documenting vital signs, height, weight, and BMI 1, 3.
- Order laboratory assessment including complete blood count and comprehensive metabolic panel 1, 3.
Multidisciplinary Team Approach
- Assemble a coordinated team incorporating medical, psychiatric, psychological, and nutritional expertise 1, 2, 3.
- Core team members should include a physician, mental health provider, and dietitian 2.
Important Clinical Pitfalls to Avoid
- Do not prescribe atypical antipsychotics like aripiprazole for binge eating disorder, as they lack evidence for efficacy and may cause weight gain, which could worsen outcomes 8.
- Avoid weight gain-inducing medications such as olanzapine, clozapine, mirtazapine, and valproate when treating patients with binge eating disorder 8.
- Do not make weight loss the primary treatment focus; instead prioritize normalizing eating patterns 2, 3.