Cognitive Behavioral Therapy and Medication for Binge Eating Disorder
There are effective treatments available for binge eating disorder (BED), concludes the authors of a new study and meta-analysis. Therapist-led cognitive behavioral therapy or CBT, the stimulant lisdexamfetamine (Vyvanse), second-generation antidepressants (SGAs) and topiramate (multiple brands) help reduce incidents of binge eating and related psychopathology, the review discovered.
Since 2013, the American Psychiatric Association officially recognized binge eating disorder as a diagnosis, and 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 at the University of North Carolina Center for Excellence for Eating Disorders in Chapel Hill.
BED is the most common eating disorder in America and it affects about 3 percent of the population. It is characterized by recurrent distress binge-eating episodes, during which a person experiences a complete lack of control and consumes large amounts of food than most people would under similar circumstances.
The new review updates and extends a 2006 review on eating disorders by reviewing 34 randomized controlled trials of treatments for binge eating disorder. Nine trials focused on psychological treatment, and 25 focused on medications. This was nearly two times as many trials as the earlier review, the team noted.
Many participants in the study achieved abstinence from binge eating with therapist-led CBT versus wait list, with lisdexamfetamine verses placebo.
Lisdexafetamine 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 sympathetic nervous system were more common with lisdexamfetamine than with the placebo.
CBT, lisdexamfeatime, and SGAs “bubble to the top as having the most evidence for effectiveness in reducing binge eating 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.
The researchers note that most of the study participants were overweight or obese white women aged 20 to 40 years of age. Many treatments were examined only in single studies, and outcomes were measured “inconsistently,” across trials and were rarely evaluated beyond the ending of treatment.
Clearly there 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 further states, “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.”