Magazine article Clinical Psychiatry News

Drug Therapy Advocated in Binge Eating Disorder: Topiramate, Sibutramine Promising

Magazine article Clinical Psychiatry News

Drug Therapy Advocated in Binge Eating Disorder: Topiramate, Sibutramine Promising

Article excerpt

DENVER -- Pharmacotherapy should now be considered an option in all patients with binge eating disorder, particularly those with concomitant mood disorders, Dr. Susan L. McElroy said at an international conference of the Academy for Eating Disorders.

"And it certainly should be considered strongly in patients who fail to respond to psychological therapy, although I personally like to give pharmacotherapy in conjunction with psychological therapy," noted Dr. McElroy, professor of psychiatry and codirector of the psychopharmacology research program at the University of Cincinnati.

In recent years, many authorities have crowned cognitive-behavioral therapy as the treatment of choice in binge eating disorder (BED), but the evidence backing use of pharmacotherapy in the setting of this most common of eating disorders has grown considerably stronger.

Three classes of medication have proved useful: antidepressants, appetite suppressants, and antiepileptic agents. All are prescribed off label since there is no Food and Drug Administration-approved medication for BED, the psychiatrist noted.

Among the agents she and her colleagues prescribe frequently are the anticonvulsants topiramate and zonisamide; various selective serotonin reuptake inhibitors (SSRIs); venlafaxine; and, as long as there is no purging and no history of anorexia nervosa or bulimia, bupropion:

* Antidepressants. The SSRIs are the best studied antidepressants in BED. Dr. McElroy and her associates don't stop at, say, 80 mg/day of fluoxetine, the maximal approved antidepressant dosage. "We go to 120-140 mg/day," she said. Even so, full remission of BED is rare with any antidepressant, and durability of the treatment response is unknown, as only short-term studies have been done so far.

When Dr. McElroy reviewed her first 30 venlafaxine-treated patients, many of whom had previously failed SSRI therapy, she found that the dual serotonin/norepinephrine inhibitor was helpful not only in reducing binge eating episodes, but also in weight loss and reduction of depressive symptoms. …

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