A New Drug Treatment for Binge-Eating Disorder

On January 30, 2015, the FDA approved the use of Vyvanse (lisdexamfetamine dimesylate) to treat binge-eating disorder (BED) in adults. This is the first medication ever approved by the FDA for the treatment of BED. But before you run out to your nearest physician to get your prescription, here are some things to know:

• BED is the most prevalent eating disorder in the United States. Despite it’s high prevalence, it has only recently been recognized as an official psychiatric diagnosis by the DSM-V.

• Vyvanse is a medication that has been approved since 2007 for the treatment of Attention Deficit/Hyperactivity Disorder (ADHD). The medication inhibits reuptake of dopamine (DA) and norepinephrine and elicits the release of monoamine neurotransmitters. Previous research suggests that binge-eating may be related to dysfunction of the DA and norepinephrine systems and it is hypothesized that Vyvanse may help improve these dysfunctions.

• A study in JAMA Psychiatry (2015) examined the effectiveness and safety of Vyvanse in the treatment of BED. Results indicate that participants who were treated with Vyvanse decreased their binge-eating behaviors when compared with the placebo group. Some participants even became abstinent from binge-eating episodes.

• Vyvanse is a medication with side effects. In the JAMA Psychiatry study, 3.1% of participants discontinued treatment due to an adverse event. 1.5% of participants experienced a serious adverse event and 1 participant died due to methamphetamine overdose. The participant who died had no previous history of substance abuse and did not test positive for illicit drugs on any of the drug screens in the research study. The researchers considered this death to be unrelated to the study drug. However, it is important to note that Vyvanse is an amphetamine. It is a schedule II controlled substance with a black box warning about the potential for abuse and dependence.

• The study excluded participants with any comorbid psychiatric conditions and certain medical conditions. Approximately 50% of people with BED also have a comorbid mood disorder and many also have comorbid medical conditions. These people were not represented in this study, which limits the generalization of results. Also, participants were predominantly female, white (non-Hispanic/non-Latino), and overweight or obese, which further limits the generalizability of study results.

• The study only included a 3-week follow-up period. The long-term effects and safety profile of Vyvanse in the treatment of BED are largely unknown.

• Vyvanse can suppress appetite. While this may initially seem like a benefit for people struggling with BED, it can actually serve to further disrupt your body’s natural hunger-fullness mechanisms. I believe that the key to recovery from BED is reconnecting with your body’s natural physiology to guide your eating without struggle. In my clinical experience, medications that suppress appetite can sometimes induce restrictive eating behaviors in patients with BED, essentially leading to a transfer of eating disorder symptoms from BED to anorexia.

My opinion: I think that we need more long-term studies to really know the effectiveness and safety of Vyvanse in the treatment of BED. In the meantime, we have research-based effective psychotherapy treatments for BED (like Mindful Eating), which don’t have the risks of side-effects that medications carry.

*This article is not intended as medical advice. As always, you should consult with your physician to discuss any concerns about your health and medication.

Reference:

McElroy S., Hudson J., Mitchell J., et al. Efficacy and Safety of Lisdexamfetamine for Treatment of Adults with Moderate to Severe Binge-Eating Disorder. A Randomized Clinical Trial. JAMA Psychiatry. Published Online 1/14/15

To learn more about Dr. Conason and Mindful Eating, please visit www.drconason.com