What are the pharmacotherapy options for Binge Eating Disorder (BED)?

From the Guidelines

Pharmacotherapy for binge eating disorder should primarily involve the use of lisdexamfetamine or antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), in conjunction with cognitive behavioral therapy or interpersonal therapy, as recommended by the American Psychiatric Association 1. The treatment of binge eating disorder typically involves a combination of psychotherapy and medication. According to the American Psychiatric Association guideline 1, patients with binge-eating disorder should be treated with eating disorder-focused cognitive-behavioral therapy or interpersonal therapy, in either individual or group formats.

• Medications such as lisdexamfetamine or antidepressants may be considered for adults who prefer medication or have not responded to psychotherapy alone 1.
• Lisdexamfetamine is the only FDA-approved medication specifically for moderate to severe binge eating disorder, and it works by regulating dopamine and norepinephrine levels, reducing binge eating episodes and associated compulsive behaviors.
• Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine may be used off-label to reduce binge frequency by improving mood and reducing obsessive thoughts about food 1. Some key points to consider when treating binge eating disorder with pharmacotherapy include:
• Treatment typically continues for at least 6-12 months, with regular monitoring for side effects and efficacy.
• Medication should ideally be combined with cognitive behavioral therapy or other psychological interventions for optimal outcomes.
• Patients should be assessed for comorbid conditions like depression, anxiety, or ADHD, which may influence medication selection 1.
• Regular follow-up appointments are essential to monitor weight, vital signs, and potential side effects specific to each medication class.

From the FDA Drug Label

The efficacy of Prozac was established in controlled clinical trials of fluoxetine supporting its effectiveness in the treatment of bulimia nervosa, patients were administered fixed daily fluoxetine doses of 20 or 60 mg, or placebo Only the 60–mg dose was statistically significantly superior to placebo in reducing the frequency of binge–eating and vomiting Consequently, the recommended dose is 60 mg/day, administered in the morning.

Pharmacotherapy for Binge Eating Disorder: The recommended dose of fluoxetine for the treatment of binge eating disorder is 60 mg/day, administered in the morning 2.

• Key Points:
  • The efficacy of fluoxetine in reducing the frequency of binge-eating and vomiting was established in controlled clinical trials.
  • A dose of 60 mg/day is recommended for the treatment of bulimia nervosa, which is characterized by binge-eating and vomiting behaviors.
  • The dose should be administered in the morning, and it may be advisable to titrate up to this target dose over several days.

From the Research

Pharmacotherapy for Binge Eating Disorder

• The efficacy of selective serotonin reuptake inhibitors (SSRIs) in treating binge eating disorder (BED) has been investigated in several studies 3, 4, 5, 6, 7.
• A network meta-analysis found that sertraline and fluoxetine could significantly reduce the frequency of binge eating, with fluoxetine showing the greatest reduction in Hamilton Rating Scale for Depression (HAMD) score 3.
• A randomized, double-blind trial comparing sertraline and fluoxetine found no significant differences between the two treatments, but both treatments resulted in significant improvement in binge frequency and weight loss 4.
• Other studies have also demonstrated the efficacy of SSRIs, such as fluvoxamine, citalopram, and venlafaxine, in treating BED 5, 6.
• Antidepressants from three categories of medication (antidepressants, appetite suppressants, and anticonvulsants) have been found to be effective in treating BED 5.
• Clinical guidelines for the use of antidepressants in BED have been established, with SSRIs being a recommended treatment option 7.

Treatment Options

• SSRIs, such as fluoxetine, sertraline, and fluvoxamine, are commonly used to treat BED 3, 4, 5.
• Other medications, such as appetite suppressants and anticonvulsants, may also be effective in treating BED 5.
• The choice of medication should be based on individual patient needs and response to treatment 4, 5.

Efficacy and Acceptability

• SSRIs have been found to be effective in reducing binge frequency and improving depressive symptoms in patients with BED 3, 4.
• The acceptability of SSRIs, as reflected by dropout rates, has been found to be high 3.
• Weight loss has been observed in some studies, but it is not a consistent finding across all studies 4, 5.