CBT, Medication Helpful for Binge Eating Disorder

Megan Brooks

June 30, 2016

Effective treatments are available for binge eating disorder (BED), conclude the authors of a new systematic literature review and meta-analysis.

Therapist-led cognitive-behavioral therapy (CBT), the stimulant lisdexamfetamine (Vyvanse, Shire), second-generation antidepressants (SGAs), and topiramate (multiple brands) help reduce binge eating and related psychopathology, the review found. Lisdexamfetamine and topiramate also reduce weight in adults with BED. Last year, lisdexamfetamine became the first medication approved by the US Food and Drug Administration for the treatment of patients with BED.

Since 2013, when the American Psychiatric Association officially recognized BED as a diagnosis, there has been a "ground swell" in attention and interest in BED "at all levels in terms of patient and practitioner awareness and demand for services, and so it seemed like it was time to update our understanding of best treatments available," lead author Kim Brownley, PhD, associate professor, University of North Carolina Center of Excellence for Eating Disorders, in Chapel Hill, told Medscape Medical News.

The study was published online June 28 in Annals of Internal Medicine.

Distressing Disorder

BED is the most common eating disorder in the United States, affecting about 3% of the US population. BED is characterized by recurrent psychologically distressing binge-eating episodes, during which individuals experience a lack of control and consume larger amounts of food than most people would under similar circumstances.

The new review updates and extends a 2006 review on eating disorders by examining 34 randomized controlled trials of treatments for BED. Nine trials focused on psychological treatment, and 25 focused on medication. This is nearly twice as many trials as in the earlier review, the researchers note.

More participants achieved abstinence from binge eating with therapist-led CBT vs wait list (58.8% vs 11.2%; relative risk [RR], 4.95; 95% confidence interval [CI], 3.06 - 8.00), with lisdexamfetamine vs placebo (40.2% vs 14.9%; RR, 2.61; 95% CI, 2.04 - 3.33), and with SGAs vs placebo (39.9% vs 23.6%; RR, 1.67; 95% CI, 1.24 - 2.26), the authors report.

Lisdexamfetamine and SGAs as a class also reduced binge eating–related obsessions and compulsions, and SGAs reduced depressive symptoms. Topiramate reduced weight and increased sympathetic nervous system arousal, and lisdexamfetamine reduced appetite and weight. Headache, gastrointestinal upset, sleep disturbance, and sympathetic nervous system arousal were more common with lisdexamfetamine than with placebo (RR range, 1.63 - 4.28).

CBT, lisdexamfetamine, and SGAs "bubble to the top as having the most evidence for effectiveness in reducing binge frequency and in some cases reaching a state of abstinence from binge eating and reducing the psychological distress that comes along with binge eating," Dr Brownley told Medscape Medical News.

The researchers note that most of the study participants were overweight or obese white women aged 20 to 40 years. Many treatments were examined only in single studies, and outcomes were measured "inconsistently" across trials and were rarely evaluated beyond end of treatment.

There "clearly" is a need for more research in binge eating, Dr Brownley said. "This [review] probably shows us more about what we don't know than what we do know. For example, we don't know the long-term effectiveness of these treatments after they end. We cannot say whether any one of these three treatments is significantly better than any of the others because there have been no head-to-head trials," she explained.

"One question I think a lot of patients and practitioners will have is which treatment to start with. Is one likely to be better than another? That's a question we just can't answer at this point," Dr Brownley added.

Detection Challenging

In a linked editorial, Michael Devlin, MD, of the New York State Psychiatric Institute, in New York City, notes that because BED is a source of shame for those affected, it may be challenging to detect.

"BED can easily be overlooked, as patients often view it as a personal failing rather than an illness that they might discuss with their doctor," he told Medscape Medical News. "So if the doctor does not ask specifically, the patient may well not bring it up. Individuals with frequent large fluctuations in weight, especially with depressive symptoms and pronounced concern with weight and shape, should be asked about binge eating and offered options for treatment if it is occurring," he advised.

"The review is indeed helpful and an excellent summary of the state of the art with regard to treatment for binge eating disorder," Dr Devlin said.

The study was funded by the Agency for Healthcare Research and Quality. Dr Brownley has received personal fees from Shire and Sunovion Pharmaceuticals outside the submitted work. Dr Devlin reports no relevant financial relationships.

Ann Intern Med. Published online June 28, 2016. Full text, Editorial

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