Binge Eating: Controlling Appetite with Medications

Suggesting medicine as a treatment for food addiction raises a red flag with many professionals. They argue that the solution to our nation’s weight problems will not be found in a bottle of pills. The concern about swallowing a pill for a quick fix seems to take away the dimension of personal responsibility.

Yet we have learned over the years that diets do not work and the epidemic of disordered eating grows at a staggering rate. Again, the common message from some of my colleagues is the simple advice embodied in the Nike slogan: just do it.

Disordered eating is not a simple problem and it isn’t resolved by a simple solution. Many components are involved. From working with thousands of patients, I have found that the most effective treatment for food addiction and binge eating is comprised of several complementary interventions. This is why I developed the New Hope model and based it upon the principles of integrative medicine.

Understanding the powerful addictive qualities of certain foods — including sugar, dairy, and gluten — will hopefully help patients appreciate the biological components of binge eating disorder and food addiction. When needed, medications can provide the biological brakes to stop disordered eating.

Using Medicine to Treat Food Addiction

Patients with disordered eating may have co-occurring psychiatric problems that are too often ignored or misdiagnosed. Anxiety, depression, bipolar disorder, Post-traumatic Stress Disorder (PTSD) and, perhaps most common, Attention Deficit Hyperactivity Disorder (ADHD) complicate effective treatment for patients struggling with disordered eating. Receptors and molecules that modulate hunger and satiety are intertwined with receptors and molecules that control emotions, behavior, and cognition.

Most of my patients have struggled to break the stranglehold of food addiction for a long time. They have worked hard. They have suffered through failed diets, endured shame, and wrought havoc with their metabolism by bingeing and often purging.

If medication can change the biochemistry that ensnares them in food addiction, why is there so much resistance on the part of professionals to use medications?

Medicine is not the enemy!

Several medications have been shown to be useful in treating patients with disordered eating. Often, treatment with a combination of medications provides permanent solutions.

As disordered eating is a complicated problem, it should be no surprise that sometimes a combination of medications is necessary to completely resolve symptoms. After all, most complicated chronic diseases—including heart disease, diabetes, cancer, and hypertension—respond best to a combination of medicines.

Selective Serotonin Reuptake Inhibitors (SSRIs)

When I consider adding medication to the essential biological foundation of nutritional therapy, I first consider the most commonly prescribed antidepressants, the selective serotonin reuptake inhibitors, or SSRIs. With professional guidance, these can be used in combination with amino acids and, if necessary, with other medications.

Neurotransmitters are chemical messengers in the brain that contain the keys to optimal brain functioning. The neurotransmitters—serotonin, dopamine, and norepinephrine—help brain cells communicate with each other. Of those, serotonin is most closely linked with mood, appetite, and a feeling of well-being. The SSRIs are a class of drugs that target serotonin.

Serotonin imbalances are also associated with depressed mood, apathy, poor impulse control, obsessive-compulsive disorder (OCD), panic disorder, and insomnia, all of which contribute to disordered eating behaviors.

Increasing the level of serotonin available in the brain may help patients reestablish a more orderly pattern of eating. Optimizing serotonin can slow the cycle of bingeing and purging. Simultaneously, it helps mitigate the effects of coexisting depression, OCD, and anxiety.

Topamax

Researchers first realized the potential of Topamax (topiramate) as a treatment for binge eating disorder when epilepsy studies showed that patients not only achieved relief from seizures but also experienced a decrease in appetite and lost weight.

This discovery led to research exploring the effects of Topamax on binge eating, bulimia, and obesity. The results of several independent studies were strikingly positive.

One study assessed the effects of Topamax and cognitive-behavioral therapy (CBT) on disordered eating. This randomized, double-blind, placebo-controlled trial involved seventy-three overweight patients.

The patients received CBT plus either 200 milligrams of Topamax or a placebo for twenty-one weeks. The patient group taking Topamax lost an average of fifteen pounds during the study, compared to an average two-pound weight loss for those in the placebo group. Furthermore, eighty-four percent of patients in the Topamax group were able to stop bingeing.

Interestingly, combining Topamax with CBT improved the efficacy of each approach. This conclusion is important because, although CBT has been consistently shown to be the most effective psychotherapy for patients with disordered eating, CBT alone is more effective in the short term than in the long term.

CBT helps patients identify distorted thinking about themselves and about food, and shows them better ways to cope with stress. Therapy may break the cycle of distorted eating for some, but medications may still be necessary in order to address underlying neurobiological disturbances. This study showed how helpful Topamax can be to sustain the positive effects from CBT.

A recent overview of several research studies of the effectiveness of Topamax in managing eating disorders concluded that Topamax reduces binge eating and night eating in overweight patients. Topamax affects not only weight and appetite but also the neural systems involved in regulating appetite to achieve hunger management.

In my practice I have rarely seen a problem with side effects of Topamax. An occasional patient has a mild problem feeling sedated until the dosage is adjusted. In most patients, side effects of Topamax occur only in higher doses (200–400 milligrams) than I typically prescribe for binge eating.

I have found low doses (25–200 milligrams) effective without causing side effects. Other side effects include numbness and tingling in the arms and legs, fatigue, changes in taste, and gastrointestinal distress. As with any medication, you should report any side effects to your physician.

Stimulants

The standard treatment for Attention Deficit Hyperactivity Disorder (ADHD) involves stimulant medications. Stimulants are a class of medications that have been used since 1938 for the treatment of attention deficits and hyperactivity. Many patients with disordered eating are often undiagnosed or never treated for coexisting disorders such as ADHD.

I frequently prescribe Topamax and stimulant medications together but prefer for patients to take them as separate medications rather than a combination pill. This allows for adjustments to be made to both medications more easily.

A medication approved for the treatment of ADHD, Vyvanse, also shows promise for treating binge eating. Phase II of the clinical trial evaluating Vyvanse was completed in 2012; Phase III yielded preliminary positive results in November 2013. And, as of February of 2015, Vyvanse was granted approval by the FDA for the treatment of binge eating disorder.

The Phase II study was a randomized, double-blind, placebo-controlled study that included 213 patients diagnosed with moderate to severe binge eating disorder. Patients’ daily food intake and binge history were monitored for eleven weeks. Patients were divided into four groups: the first received the placebo, the second a dose of 30 milligrams of Vyvanse daily, the third a daily dose of 50 milligrams, and the fourth 70 milligrams of Vyvanse per day.

Researchers observed differences in the number and frequency of binge episodes. The patients on 50 milligrams experienced a decrease in bingeing from 4.540 to 0.310 days per week. Taking 70 milligrams of Vyvanse, patients’ binge frequency decreased from 4.470 to 0.011 after the trial. The most dramatic difference: a total elimination of binge episodes for one entire week, a benchmark achieved by week eleven of the trial. Sixty-seven percent of patients in the group taking 70 milligrams of Vyvanse were free from bingeing for the last week, compared to fifty-six of patients on the 50 milligrams dose and thirty-four percent of patients on the placebo.

Phase III studies had an enrollment of 773 patients ages eighteen to fifty-five with moderate to severe binge eating disorder. Patients were randomized to Vyvanse or placebo treatment groups, and all Vyvanse-treated patients began at a dose of 30 milligrams before the dose was increased to either 50 or 70 milligrams. In both of these studies, Vyvanse was found to be more effective than the placebo in reducing the number of binge days per week.

Stimulant medications increase the availability of the neurotransmitter dopamine. We know that enhancing dopamine production can play an important role in regulating the binge eating cycle and curbing food addiction. I have seen in my practice that when I prescribe a stimulant drug to treat ADHD, it also helps to blunt the cravings and lack of impulse control that underlie binge eating.

Like many medications, stimulants can be abused. Some patients with eating disorders have used stimulants to help restrict their eating in an unhealthy way. In my experience, patients with binge eating disorder do not tend to abuse these medications. Instead, these patients find considerable gratification and improved self-esteem through finally being able to control the desire to binge and obtaining relief from long-untreated symptoms of ADHD.

Takeaway

Research into medications to treat disordered eating is still in its early stages. At present, fluoxetine (Prozac) and Lisdexamfetamine (Vyvanse) are the only medications approved by the FDA for treating eating disorders. Many of the medication study results now available have limitations, including small sample size and a sole focus on one medication only.

In addition, with the exception of obesity and major depressive disorder, there has been no large scientific study of medication results in patients with food addiction and co-occurring psychiatric conditions. We need studies conducted on combinations of drugs—for instance, Topamax together with SSRIs—as a basis to help determine optimal treatment regimens for individual patients.

Although research into the effectiveness of medication combinations is in its early stages, I have seen successful outcomes in patients for whom I have prescribed such a combination. In many cases, the results are astonishing.

Women and men have reported freedom from compulsions to binge, and elation over weight loss that they had previously believed impossible to achieve or maintain. According to the New Hope model, medications can be a helpful and, sometimes, essential part of treatment for some people.

In tandem with therapy and nutritional supplements (i.e. nutritional psychiatry), medications may be the critical component of an integrative intervention to end the roller-coaster ride of disordered eating.

Although medication is not a simple fix for disordered eating, it can provide valuable biological support as part of an integrative plan to restore normal eating and a healthier relationship with food.

DISCLAIMER: Prior to medication being approved for use in patients in the United States, the Federal Drug Administration (FDA) mandates the drug be tested in humans in clinical research trials. Each trial looks at one or more specific areas where the drug must prove itself to be effective. For each area of effectiveness that is studied and proven, the manufacturer receives an “approved medication” for which the drug can be marketed and sold. Commonly medications appear to be effective and are often ultimately studied and proven to be effective for conditions other than the original “approved medication(s).” This is where a physician discusses their experience in using a specific drug for a non-FDA-approved medication indication including its effectiveness and safety. The medications discussed in this article are not FDA approved for the treatment of binge eating disorder.

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