What Medications Treat Binge Eating Disorder?
Medications used to treat binge eating disorder generally have been found to help with weight loss or to reduce the compulsive eating binges, but few have clearly helped with both. Until recently, no medications had received a Federal Drug Administration (FDA) approval for treating binge eating disorder. This does not mean that other medications are not helpful, just that no company obtained approval for their medications to treat binge eating disorder. In 2014, one of the stimulant medications also approved for treating attention deficit hyperactivity disorder (ADHD), lisdexamfetamine (Vyvanse), was approved for treating binge eating disorder.
1. Stimulant medications: Stimulants are most often prescribed for attention deficit disorder (ADD) or ADHD. However, stimulants have also been used to suppress appetite and to help with weight loss. These medicines work by increasing dopamine and noradrenaline (norepinephrine) in the brain. As mentioned previously, these brain chemicals are involved with reward pathways and addictive behaviors. Since overeating and bingeing may be related to these brain systems, lisdexamfetamine was studied to determine if it could both decrease binge eating and help with weight loss. Patients with moderate to severe binge eating disorder showed reduced bingeing behavior and modest weight loss during the 12-week trial period. Although other stimulant medications, such as methylphenidate (Ritalin, Concerta) or mixed amphetamines (Adderall, dexamphetamine) have not been FDA approved for binge eating disorder, they work through the same brain systems and may also have benefits for treating binge eating disorder. However, as with any prescription medicine, they should only be used when prescribed by a doctor. These medicines can be addictive and could have serious side effects if used improperly.
2. Serotonin specific reuptake inhibitors (SSRIs): These are probably the most prescribed antidepressant and anti-anxiety medications. They have shown significant benefit for many people with depression, obsessive-compulsive disorder (OCD), and generalized anxiety disorder. They have also been used for other impulsive or compulsive behavior. This class of medications includes fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), and paroxetine (Paxil). SSRIs have been found to effectively suppress binge eating and may slightly reduce weight. These agents are generally well tolerated. They also have the advantage of potentially treating comorbid depression and anxiety.
3. Anticonvulsant medications: Anticonvulsant medications were developed to treat epilepsy and seizures. Some of them have also been used for headaches, other neurologic conditions, or as mood stabilizers for bipolar disorder. The anti-epileptic agent topiramate (Topamax) is known to have a side effect of significant weight loss in some individuals. For this reason, it has been tried as a treatment to encourage weight loss and in binge eating disorder. Topiramate has been used experimentally now in a number of trials in individuals with binge eating disorder. These trials have shown reductions in binge eating episodes and weight loss, many times involving weight reductions in excess of what is seen with other pharmacological interventions. Unfortunately, the use of topiramate has been limited by other side effects, including sedation and cognitive (thinking) problems. Another anticonvulsant, zonisamide (Zonegran), showed similar effects on binge eating frequency and weight loss in a smaller number of studies. However, like individuals taking topiramate, many people stopped taking the medication because of side effects (sedation, cognitive problems, and psychological problems). Most other anticonvulsant medications are commonly associated with weight gain and may be counterproductive in binge eating disorder. Others, such as lamotrigine (Lamictal), have only very limited data on how effective they may be in treating binge eating disorder.
4. Other medications: Other classes of antidepressants, including tricyclic antidepressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), have also been studied for binge eating disorder treatment. TCAs are older antidepressants and also can decrease binge eating and improve depression and anxiety. However, they have more risk of side effects and do not result in significant weight loss. Similar to SSRIs, SNRIs may decrease binge eating and modestly reduce weight.
Other weight loss medications have also been considered for binge eating disorder treatment. Sibutramine was another stimulant weight loss drug that reduced binge eating and weight but was taken off the market by the FDA due to safety concerns (cardiac side effects and strokes). Orlistat is a weight loss drug that works by blocking the absorption of fats from the diet. Orlistat may improve weight loss during binge eating disorder treatment but commonly causes gastrointestinal side effects.