What medications are used to treat binge eating disorder (BED)?

From the Guidelines

Patients with binge-eating disorder should be treated with eating disorder-focused cognitive-behavioral therapy or interpersonal therapy, and medication such as lisdexamfetamine or an antidepressant may be considered for those who prefer medication or have not responded to psychotherapy alone. The American Psychiatric Association recommends 1 that patients with binge-eating disorder be treated with eating disorder-focused cognitive-behavioral therapy or interpersonal therapy, in either individual or group formats. Some key points to consider when treating binge eating disorder include:

• Lisdexamfetamine is the only FDA-approved medication specifically for binge eating disorder 1.
• Antidepressant medications may also be effective in treating binge eating disorder 1.
• Medication is most effective when combined with psychotherapy, particularly cognitive behavioral therapy 1.
• Treatment typically continues for at least 6-12 months, with regular monitoring for side effects.
• Lifestyle changes including regular meals, stress management techniques, and avoiding trigger foods can enhance treatment success 1. Key considerations for medication selection include:
• Lisdexamfetamine is typically started at 30mg daily and potentially increased to 50-70mg daily.
• Antidepressants like fluoxetine (Prozac) at 20-80mg daily, sertraline (Zoloft) at 50-200mg daily, may be used to treat binge eating disorder 1. It is essential to discuss the patient's complete medical history with their doctor before starting any medication to ensure appropriate treatment selection 1.

From the FDA Drug Label

Lisdexamfetamine dimesylate capsules are a central nervous system (CNS) stimulant prescription medicine used for the treatment of: Moderate to severe binge eating disorder (BED) in adults. Lisdexamfetamine dimesylate capsules may help reduce the number of binge eating days in people with BED.

Binge Eating Medication: Lisdexamfetamine dimesylate capsules are approved for the treatment of moderate to severe binge eating disorder (BED) in adults. The medication has been shown to reduce the number of binge eating days in people with BED.

• The primary efficacy outcome was defined as the change from baseline at Week 12 in the number of binge days per week.
• Subjects on lisdexamfetamine dimesylate capsules had a statistically significantly greater reduction from baseline in mean number of binge days per week at Week 12 2. Key points:
• Lisdexamfetamine dimesylate capsules are used to treat BED in adults.
• The medication reduces the number of binge eating days.
• It is not approved for use in children with BED 2.

From the Research

Binge Eating Medication

• Lisdexamfetamine is currently the only drug approved in the USA for the treatment of moderate to severe binge eating disorder (BED) in adult patients 3.
• The approval of lisdexamfetamine was based on the results of two pivotal short-term phase III studies, which showed a significantly greater reduction in binge eating days/week at the end of the study with lisdexamfetamine 50-70 mg/day than with placebo 3.
• Lisdexamfetamine was generally well tolerated in clinical trials in patients with moderate to severe BED, with a tolerability profile similar to that observed in ADHD patients 3.
• The most common treatment-emergent adverse events (TEAEs) in phase III trials included dry mouth, headache, and insomnia; TEAEs infrequently led to study drug discontinuation 3.

Mechanism of Action

• The evidence on the mechanism of action of lisdexamfetamine suggests that it may reduce binge eating by a combination of effects on appetite/satiety, reward, and cognitive processes, including attention and impulsivity/inhibition, that are mediated by catecholamine and serotonin mechanisms in the brain 4.
• Preclinical studies have shown that lisdexamfetamine reduces food intake, but there is no consistent evidence for a preferential reduction of palatable food consumption by the drug in rodents 4.

Patient Perceptions

• Patient perceptions of lisdexamfetamine as a treatment for binge eating disorder have been explored in a qualitative and quantitative analysis, which found that themes associated with higher efficacy ratings included improved binge eating outcomes, enhanced focus/concentration, and weight loss 5.
• Lower efficacy ratings were associated with themes that included tolerance to therapeutic effects of lisdexamfetamine, insomnia, return of binge eating in the evening, loss of energy in the afternoon/evening, and weight gain 5.

Pharmacological Treatment

• Several medications have proven to be effective for the treatment of binge eating disorder, including lisdexamfetamine, topiramate, as well as anti-anxiety and antidepressant medications 6.
• Lisdexamfetamine is the only FDA-approved medication for binge eating disorder, and its use should be preferred as a general rule 6.
• Combination approaches with psychological-behavioral methods and certain medications may yield superior outcomes to pharmacotherapy-only 7.