Management of Increased Binge Eating After Stopping Adderall XR in ADHD with Comorbid Binge Eating Disorder
Restart Adderall XR (or switch to another amphetamine-based stimulant) immediately, as amphetamine medications are the only FDA-approved pharmacological treatment for binge eating disorder and provide dual benefit for both ADHD and BED. 1, 2
Rationale for Amphetamine-Based Stimulant Treatment
The increased excessive eating after stopping Adderall XR represents both:
- Rebound of untreated binge eating disorder symptoms that were being suppressed by the amphetamine's therapeutic effect on BED 3, 4
- Loss of ADHD symptom control, which worsens the impulsivity and cognitive dyscontrol that drive binge eating behaviors 3, 5
Evidence Supporting Amphetamine Treatment for BED
- Lisdexamfetamine (Vyvanse) at 50-70 mg/day is the only FDA-approved medication for moderate to severe BED, demonstrating significant reductions in binge eating days per week compared to placebo 1, 2
- In pivotal trials, lisdexamfetamine 50-70 mg/day achieved 4-week binge eating cessation rates of 42.2% and 50.0% respectively, compared to 21.3% with placebo 2
- The mechanism involves augmenting noradrenergic and dopaminergic neurotransmission, which reduces the core psychopathologies of impulsivity, compulsivity, and perseveration while increasing cognitive control of eating 3, 4
Specific Treatment Algorithm
First-Line Option: Resume or Switch Amphetamine Formulation
Option 1: Restart Adderall XR at the previous effective dose for ADHD, which should simultaneously address both conditions 6, 5
Option 2: Switch to lisdexamfetamine 50-70 mg/day, which provides:
- Once-daily dosing with prodrug formulation reducing abuse potential 7
- FDA approval specifically for BED treatment 1, 2
- Demonstrated efficacy for both ADHD and BED with mean weight reduction of 4.3-4.9 kg 2, 5
Monitoring Parameters
- Binge eating days per week - quantify weekly to assess treatment response 2
- Weight and vital signs (blood pressure, heart rate) at each visit 6
- ADHD core symptoms using standardized rating scales 6
- Treatment response timeline: Expect reduction in binge eating within 3-11 weeks, with continued improvement up to 52 weeks 2, 4
Common Pitfall to Avoid
Do not use non-stimulant ADHD medications (atomoxetine, guanfacine, clonidine) as first-line treatment in this scenario. While these are appropriate second-line options for ADHD alone, they have:
- Smaller effect sizes (0.7 vs 1.0 for stimulants) for ADHD 7
- No established efficacy for binge eating disorder 3, 5
- Delayed onset of 2-12 weeks versus rapid stimulant effects 6
Alternative if Amphetamines Are Contraindicated
If stimulants cannot be used due to contraindications (active substance use disorder, uncontrolled cardiovascular disease, severe anxiety):
Topiramate is the only non-stimulant with evidence for BED treatment, though it lacks FDA approval for this indication 5
Combination approach for severe cases:
- Atomoxetine for ADHD (60-100 mg daily, allowing 6-12 weeks for full effect) 7
- Plus cognitive behavioral therapy specifically targeting binge eating behaviors 8
- Consider adding liraglutide or semaglutide if obesity is present, as these GLP-1 agonists reduce binge eating in individuals with overweight 5
Critical Clinical Context
The patient's worsening binge eating after stopping Adderall XR demonstrates that BED was being effectively treated by the amphetamine, even if this wasn't the original indication 3, 4. This represents a common clinical scenario where stimulant treatment for ADHD provides unrecognized benefit for comorbid BED 5. The overlap in pathophysiology—both conditions involve impaired dopaminergic and noradrenergic neurotransmission affecting impulse control—explains why amphetamines effectively treat both disorders simultaneously 3, 4.