Binge eating medication
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Pharmacologic Treatment of Binge Eating Disorder (BED)
Introduction to Binge Eating Disorder and Medication
Binge Eating Disorder (BED) is the most prevalent eating disorder in the United States, characterized by recurrent episodes of eating large quantities of food, often quickly and to the point of discomfort. This disorder is associated with significant psychological distress and various comorbidities, including obesity and metabolic syndrome 46. While psychological treatments have been the cornerstone of BED management, pharmacologic interventions are increasingly recognized as essential components of a comprehensive treatment strategy 59.
Antidepressants and Appetite Suppressants
Several classes of medications have shown efficacy in treating BED. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, sertraline, and citalopram, have demonstrated significant reductions in binge-eating episodes in placebo-controlled trials 13. Appetite suppressants such as sibutramine and dexfenfluramine have also been effective in reducing binge frequency and promoting weight loss 13.
Anticonvulsants and Substance Abuse Treatment Agents
Anticonvulsants like topiramate have shown promise in reducing binge-eating episodes and associated psychopathology. Topiramate, in particular, has been noted for its dual benefits of reducing binge frequency and promoting weight loss 18. Additionally, medications typically used for substance abuse treatment, such as naltrexone and acamprosate, are being explored for their potential benefits in BED due to the overlapping neurobiological pathways involved in addiction and binge eating 35.
Lisdexamfetamine: The FDA-Approved Option
Lisdexamfetamine (LDX) is the only medication currently approved by the FDA specifically for the treatment of BED. Clinical trials have consistently shown that LDX is effective in reducing the number of binge-eating days and promoting weight loss 46. The drug's mechanism of action involves modulating appetite, reward, and cognitive processes through catecholamine and serotonin pathways in the brain 4. However, the safety profile of LDX necessitates careful monitoring due to potential adverse effects such as increased heart rate and blood pressure 6.
Combination Therapies: Behavioral Weight Loss and Pharmacotherapy
Combining pharmacotherapy with behavioral interventions, such as Behavioral Weight Loss (BWL) therapy, has shown superior outcomes compared to either treatment alone. A randomized controlled trial demonstrated that the combination of naltrexone-bupropion with BWL resulted in the highest rates of binge-eating remission and significant weight loss compared to placebo or either treatment alone 2. This suggests that a multimodal approach may be the most effective strategy for managing BED 27.
Emerging Treatments and Future Directions
New pharmacological agents are being investigated for their potential in treating BED. These include centrally acting sympathomimetics, nootropics, and other novel compounds targeting the neurobiological underpinnings of the disorder 35. Despite promising short-term results, the long-term efficacy and safety of these treatments remain to be fully established. Future research should focus on larger, more definitive trials and explore the mechanisms through which these medications exert their effects 3510.
Conclusion
Pharmacologic treatment of BED involves a variety of medications, including antidepressants, appetite suppressants, anticonvulsants, and substance abuse treatment agents. Lisdexamfetamine remains the only FDA-approved medication specifically for BED, showing significant efficacy in clinical trials. Combining pharmacotherapy with behavioral interventions appears to offer the best outcomes. Ongoing research into new pharmacological treatments holds promise for more effective and comprehensive management of BED in the future.
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Most relevant research papers on this topic
Pharmacologic treatment of binge eating disorder.
Pharmacologic treatment of binge eating disorder (BED) involves the use of antidepressants, appetite suppressants, and anticonvulsants from three categories (antidepressants, appetite suppressants, and anticonvulsants).
Systematic Review
Highly CitedNaltrexone-Bupropion and Behavior Therapy, Alone and Combined, for Binge-Eating Disorder: Randomized Double-Blind Placebo-Controlled Trial.
Naltrexone-bupropion and behavioral weight loss therapy significantly improve binge-eating disorder, with behavioral weight loss therapy being more effective than no therapy.
RCTPharmacotherapy of Binge-Eating Disorder: A Review
Pharmacotherapy, including antidepressants, anticonvulsants, and antiobesity agents, shows promise in reducing binge eating, weight gain, and improving psychopathology in binge eating disorder patients.
Systematic ReviewLisdexamfetamine and binge-eating disorder: A systematic review and meta-analysis of the preclinical and clinical data with a focus on mechanism of drug action in treating the disorder
Lisdexamfetamine is an effective treatment for binge-eating disorder, reducing symptoms and body weight, with limited evidence on its mechanism of action.
Meta-AnalysisInvestigational drugs for the treatment of binge eating disorder (BED): an update
Pharmacological interventions like lisdexamfetamine and dasotraline show promise in treating binge eating disorder, but larger, more definitive trials are needed for confirmation.
Systematic ReviewEfficacy and safety of lisdexamfetamine for treatment of adults with moderate to severe binge-eating disorder: a randomized clinical trial.
Lisdexamfetamine dimesylate effectively reduces binge-eating behaviors and is generally well-tolerated by adults with moderate to severe binge-eating disorder.
RCT
Large Human TrialHighly CitedMeta-Analysis of the Efficacy of Psychological and Medical Treatments for Binge-Eating Disorder
Psychotherapy, structured self-help treatment, and pharmacotherapy are effective for patients with binge-eating disorder.
Meta-AnalysisHighly CitedCurrent and emerging drug treatments for binge eating disorder
Certain medications are superior to placebo for stopping binge eating and producing faster reductions, but weight loss is minimal with them, except for topiramate.
Systematic ReviewBinge eating disorder treatment: a systematic review of randomized controlled trials.
Binge eating disorder treatment efficacy is variable, with individual or group CBT reducing binge eating and improving abstinence rates but not leading to weight loss.
Systematic ReviewHighly CitedReview and Meta‐analysis of Pharmacotherapy for Binge‐eating Disorder
Pharmacotherapies may enhance short-term remission from binge eating and modest weight loss in binge-eating disorder patients, but long-term effects are unknown and long-term effects of combining medications with psychotherapy are unclear.
Meta-Analysis
Very Rigorous JournalHighly Cited