What is the optimal treatment for Binge Eating Disorder (BED) in a patient with cardiac disease?

From the Guidelines

The most effective treatment for binge eating disorder in cardiac patients is eating disorder-focused cognitive-behavioral therapy or interpersonal therapy, which can be delivered in individual or group formats, as recommended by the American Psychiatric Association 1. When managing binge eating disorder in cardiac patients, it's crucial to consider the potential cardiovascular risks associated with certain medications.

• Cognitive-behavioral therapy (CBT) is a first-line treatment, focusing on normalizing eating patterns, identifying binge triggers, and developing coping strategies.
• Interpersonal psychotherapy (IPT) is also effective, addressing relationship issues that may contribute to binging behaviors. For medication, selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) at 20-60 mg daily or sertraline (Zoloft) at 50-200 mg daily may be prescribed, but require careful cardiac monitoring due to potential QT interval prolongation 1.
• Lisdexamfetamine (Vyvanse) at 30-70 mg daily is FDA-approved for BED but should be used cautiously in cardiac patients due to potential increases in blood pressure and heart rate. Regular cardiac monitoring is essential, including blood pressure checks, ECGs, and electrolyte monitoring, as well as nutritional counseling emphasizing regular, balanced meals rather than restriction, which can trigger binges 1. Treatment should also address comorbid conditions like depression or anxiety that often accompany BED, and lifestyle modifications such as smoking cessation, improving diet, moderate alcohol consumption, reducing dietary salt, and increasing physical activity can also be beneficial 1.

From the FDA Drug Label

The recommended dose is 60 mg/day, administered in the morning. For some patients it may be advisable to titrate up to this target dose over several days. A lower or less frequent dosage should be used in patients with hepatic impairment. A lower or less frequent dosage should also be considered for the elderly, and for patients with concurrent disease or on multiple concomitant medications.

The best treatment for binge eating disorder in a cardiac patient is fluoxetine 60 mg/day. However, a lower or less frequent dosage should be considered for patients with concurrent disease, such as cardiac disease, or on multiple concomitant medications.

• Key considerations:
  • Dose titration: titrate up to the target dose over several days
  • Concurrent disease: consider a lower or less frequent dosage
  • Multiple concomitant medications: consider a lower or less frequent dosage 2

From the Research

Treatment Options for Binge Eating Disorder in Cardiac Patients

• The most effective treatment options for binge eating disorder include cognitive behavioral therapy (CBT) 3, 4, 5, interpersonal psychotherapy (IPT) 3, and guided self-help (GSH) 3, 5.
• CBT has been shown to be effective in reducing binge eating frequency and increasing binge eating abstinence 4, and can be delivered in various formats, including individual, group, and guided self-help, with no significant differences between formats 5.
• Lisdexamfetamine and second-generation antidepressants (SGAs) have also been found to be effective in reducing binge eating frequency and increasing binge eating abstinence 4.
• Topiramate has been shown to reduce weight and increase sympathetic nervous system arousal, and lisdexamfetamine has been found to reduce weight and appetite 4.

Considerations for Cardiac Patients

• When treating cardiac patients with binge eating disorder, it is essential to consider the potential interactions between medications and cardiac conditions 6.
• Selective serotonin reuptake inhibitors (SSRIs) have been used to treat eating disorders, but their effectiveness in cardiac patients is not well established 6.
• CBT and other psychological therapies may be a safer and more effective option for cardiac patients, as they do not involve the use of medications that may interact with cardiac conditions 3, 4, 5.

Key Findings

• CBT is a highly effective treatment for binge eating disorder, with large and significant effects compared to waitlists 5.
• Lisdexamfetamine, SGAs, and topiramate have been found to be effective in reducing binge eating frequency and increasing binge eating abstinence 4.
• Guided self-help and individual therapy formats have been shown to be effective in treating binge eating disorder, with no significant differences between formats 5.