What Drugs Are Used To Treat Binge Eating Disorder?

BED is a very severe and complex clinical issue because of its association with high psychiatric comorbidity and suicidal risk. Individuals with binge eating disorder (BED) and ADHD have high rates of comorbidity.[1, 2] Antidepressant treatment is often recommended as binge eating disorder treatment because of its association with neurobiological factors, depressive and obsessional psychopathology and high rates of comorbidity factors. [3] [4]

The objectives of Drug Treatment of Binge Eating Disorder

·        To prevent the possibility of the individual returning to binge eating after recovery [5]

·        To treat comorbid psychopathology like overweight and restore patients to healthy weights.

·        To address significant behavioral conflict in BED like distress, low self-worth, and impulsive eating.

·        To improve patient’s acceptability, total wellbeing and solicit support of the family members of binge episode victims

·        To address dysfunctional behavioral regulation

·        To enhance associated psychological difficulties and treat physical complications

 

Treatment for binge eating disorder

The key role of binge eating disorder treatment is to minimize binge eating habits and possibly help the individual to lose weight. Given that binge eating is associated with a feeling of remorse, embarrassment and low self-esteem, binge treatment is as well targeted at eradicating the psychological effects of binge eating.

Recent studies suggest that the best-recommended treatment for binge eating disorder is through psychotherapeutic methods.  [6, 7, 8,9]

However, drugs greatly help to eradicate binge eating episodes especially in conjunction with psychotherapy and other treatment methods. A few scientific studies propose a multidisciplinary treatment approach to binge eating disorder [5, 10]

There are different classes of medication used in the treatment of binge eating disorder. These include antidepressants, anticonvulsants, and anti-obesity drugs. [11, 12]

Psychotropic medicine especially antidepressants and antipsychotics are substantially used in binge eating disorder to treat comorbid symptoms with Fluoxetine, escitalopram, and aripiprazole the most popular. [13]

Drugs used in the treatment of binge eating disorder

Lisdexamfetamine dimesylate (Vyvanse)

 Vyvanse (lisdexamphetamine) is at present the only FDA-approved medication for the treatment of binge eating disorder. It is particularly recommended for moderate and severe BED in adults at 50 to 70 mg daily. [14, 15]  

The medical condition of persons under the prescription of Vyvanse like blood chemistry, bone health, toxicology and GI conditions must be adequately monitored. [5]

There is inadequate data regarding the success rate of Vyvanse in adults with mild binge eating episodes or teens and elderly with associated comorbid behaviors like moodiness and fretfulness. [16] Vyvanse is not a weight loss treatment option.

Common side effects of Vyvanse are sleeplessness, increased heart rate, dry mouth, jittery feelings, constipation, and nervousness. However, it can lead to more serious side effects like:

·              Psychiatric problems

·              Heart complications which include sudden death in people with heart disease or heart defects, 

·              Stroke and heart attack in adults

·              Psychotic or manic symptoms like: Phantasm, manic disorder, even in individuals without previous history of psychotic illness. [15]

Antipsychotic medications

Antipsychotic medications like Anxiolytics and mood stabilizer lithium carbonate are only a recommended treatment option for binge eating when the patient has associated psychotic symptoms.

A study found that Psychostimulant medications utilized in the management of ADHD to target the dopamine system and control behavior also help to in management of binge eating. [2]

A study by McCann and Agras found that desipramine reduces binge-eating episodes, binge eating associated with stress and helps to curb appetite. Another

McCann and Agras also found that tricyclic antidepressants are useful at reducing short-term binge-eating episodes.

Anticonvulsant medications

Studies found that anticonvulsant medications like topiramate and  zonisamide can suppress appetite which leads to binge eating [11]

 

Antidepressant medications

Studies show that antidepressant drugs that belong to the class of the selective serotonin reuptake inhibitor (SSRI) class like fluoxetine,

fluvoxamine, sertraline, citalopram or escitalopram helps to reduce binge eating episodes. The risk associated with them is also minimal. [5, 16, 11]

Antidepressants should be carefully prescribed starting with small initial doses and a gradual dosage increase. Toxic serum concentrations may build up at comparatively small doses. Thus, the dosage levels must be adequately monitored from time to time. [17]

Selective serotonin reuptake inhibitors

Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may be helpful. A trial study on SSRI treatment of binge-eating found that fluvoxamine reduces binge-eating episodes but has no effect on depressive symptoms comorbidity [18]

Its associated side effects are insomnia, nausea, and abnormal dreams. [18]

A trial study show that a combination of fluoxetine and phentermine, a dopamine discharging agent with cognitive behavioral therapy proved more successful as treatment of binge eating than treatment with only cognitive behavioral therapy. [18]

SSRIs are good short-term treatment options for persons with binge eating habit. [18]

D-Fenfluramine

D-Fenfluramine has serotonergic effects and that it serves as an excellent is an appetite suppressant and is a short-term highly efficient treatment of an acute binge-eating disorder. However, it is a risk factor to valvular abnormalities [18]

Naltrexone

A study found that Naltrexone when combined with fluoxetine or psychotherapy significantly helps to reduce episodes of binge eating which implies that opiate obstruction is a potential clinical treatment for binge-eating disorder. [18]

Oxcarbazepine

Research conducted by the psychiatry Department of Neurosciences, University of Turin, Italy found that oxcarbazepine is especially great at eradicating perceptible impetuous binge eating.

Oxcarbazepine as well helps to the related psychological effects of binge eating like in mood, anger, and disruptive behavior. However, the study proposes using Oxcarbazepine together with other forms of treatment instead of exclusively. [19]

 

Self-Help techniques for Binge Eating Disorders

Sufferers of binge eating disorder (BED) experience recurring binge eating episodes, recurrent comorbid obesity with related health issues [1], increased rates of associated psychiatric disorders [2] and impairment of the psyche.[3] A lot of psychological treatments have been discovered as great remedies and treatments for BED [4]. These include cognitive-behavioral therapy [5], interpersonal therapy [5], dialectical behavior therapy [6], and behavioral weight loss therapy [7].

Although medications reduce binge eating episodes in a number of studies [8, 9], pharmacological treatment of binge eating disorders is less successful than evidence-based psychotherapy. Medications have also not improved binge episodes reduction rates when merged with cognitive behavioral therapy [10].

In a bid to discover a more cost effective and efficacious treatment for BED, a lot of scientific studies were carried out. The results showed that cognitive-behavioral and psycho-educational therapy managed through self-help procedures [11] or guided self-help procedures have helped to reduce binge eating in individuals with binge eating disorder. [12] These self help cognitive therapies were managed individually in all the studies except one which was conducted as a group. [12]



Nevertheless, some psychotherapy studies for people with binge eating disorder were carried out through the use of group method. The management of self-help therapy in a group situation is beneficial in a lot of ways.



Benefits of group self help BED treatment



Some of the benefits of group self-help treatment strategy are: cost reduction, the possibility of helping many people at a time and support from members of the group.



A study found that group self-help remedy for binge eating disorder produced similar effect [13] to therapist-led and therapist-assisted group cognitive-behavior psychotherapy during after-treatments [14] and follow-up treatments(15).



Why self-Help remedies?

Due to the fact that comprehensive treatment of BED is quite costly and because there are only few special programs and available experts to take care of the needs of people with BED, a few experts created self-help remedy for binge eating disorders.

These self-help remedies are commonly structured to provide people suffering from binge eating disorders with management tools and resources that will help them to deal with binge eating on their own. These self help remedies are usually structured from proven psychological treatments.

What is involved in self help remedy?

Self-help remedies for BED involve the following:

· Provision of useful resources or manual to guide the individual on what to do and what not to do [16]

· Provision of professional support by an expert

· The need for binge sufferers to strictly follow the advice provided in the program.

· Ability of binge sufferers to complete exercises and tasks offered in the program with the intention of developing fresh skills to help them conquer the binge eating episodes.


Cognitive behavioral self-help

The majority of the self-help remedies provided by experts for eating disorders are structured on the principles of cognitive behavioral therapy (CBT). The majority of health care professionals prefer individual CBT. [16]

During the primary stage of CBT, the sufferers of binge episodes receive training on how to manage their binge eating. They also learn behavioral strategies to help them return to normal eating habit and avoid abnormal eating behaviors. At this stage, they also learn how to discover abnormal eating thoughts and things that may trigger the symptom.[16]

The second stage

The second stage still centers on developing normal eating habits. Participants also learn problem solving skills, and how to discover and change tricky thinking or ideas.

Third stage

At this stage, the participants learn how to maintain the principle that they are thought and avoid returning back to the disordered thinking and binge eating habit. [16]

The problem with cognitive behavioral treatment for binge eating is that it is very costly and takes a lot of time. There is also no extensive availability of therapists. Nevertheless, due to the fact that CBT is a prearranged therapy that focuses on instructional, behavioral, and cognitive theories, it is easily converted into a self-help arrangement. Thus, in CBT self-help remedies, binge sufferers on their own learn how to use the behavioral and cognitive strategies that have proved to be effective through research to conquer their eating disorders. [16]


Guided self-help and unguided self help treatments



In unguided self help, binge sufferers make use of resources and manuals presented in the form of books, videos, DVDs, CD-ROMs and so on to learn how to manage their binge eating episode by themselves. [17]

An individual can as well make use of self help materials and book some sessions with a healthcare professional. This is referred to as guided self help. The aim of this would be to reduce the number of sessions the individual will have with a therapist, the treatment period and the cost of treatment. The individual would normally learn a lot from the manual outside the standard treatment session.

The health care professional doesn’t have to be specialist in the area to help the individual. This is so, because, any professionally formulated self-help manual basically come with enough expert information required to assist people to conquer their binge eating habits. The non-professional thus, only acts provide the individual with support and act as a guide to ensure that the binge sufferers efficiently complete the program. [17]

One great benefit of guided self help program is that it ensures that the participants to remain on track while in an unguided self help, the individual may lose track except the individuals are highly motivated and determine and have enough self will to propel them to finish the entire task provided in the program. [17]

Studies that compared guided and unguided self-help programs like Carter and Fairburn (1998) [18] found that both guided self self-help and unguided self help treatments led to huge reductions of binge eating episode and none is better than the other.



Ghaderi and Scott (2003) [19]also found that both guided and unguided self-help treatment resulted in reduction of binge eating and as well helped participants to lose weight. They also found that neither of the two is better than the other.

Online self-help treatment

There is also option of online self-help treatment programs. A research conducted on this, showed that online self help treatment program is equally as beneficial as guided and unguided self help treatment. [20]



When is self help treatment recomended?



Self-help treatments can be used as the first treatment for [21] binge eating disorder. If it is not yielding the required result, you may then seek specialist attention.

You can as well use it while on the waiting list of starting off treatment with professional therapists. It can help the individuals to live a better quality of life while waiting for their appointment dates.

Some people do very well on their own while others need group support from the group setting to be more successful. [21]

Therapy For Binge Eating Disorder: Steps Your Therapist Will Take To Help You Recover

Binge eating disorder (BED) was publicly acknowledged as an official diagnosis in the fifth publication of the Diagnostic and Statistical Manual of Mental Disorders [1, 2] by the American Psychiatric Association [3] in 2013. Binge eating is not just all about food. It involves similar sections of the brain that is connected with neurotransmitters and many other similar symptoms [4]. Series of research show that psychotherapy is more effective binge eating disorder treatment than medical or pharmacological interventions. [5, 6]

The purposes of psychological treatment of Binge eating disorder are to reduce the risk associated with binge eating, enhance positive weight gain and encourage healthy eating. [7] Psychological treatment is made up of a succession of therapeutic sessions in which a healthcare provider works with a patient individually, in a group of related patients or together with their family to assist patients to manage their binge eating issues.

The most frequently used psychotherapeutic treatments for binge eating disorder are:

Self-help

Self-help may be proposed to you as your first line of treatment. Your General Practitioner or other healthcare experts may guide you on how to go about it. If you have a minor binge eating disorder issue, self help may be able to help you to resolve the issue and get back to normal. In some instances, you may not require any additional form of treatment to overcome your issue with binge eating. If you have a more serious and unrelenting binge eating disorder, you may be referred to go for the following psychological treatments: [8]

·        Cognitive analytic therapy (CAT)

·        Cognitive behaviour therapy for binge eating disorder (CBT-BED)

·        Interpersonal psychotherapy (IPT)

·        Modified dialectical behaviour therapy (DBT).

Cognitive analytic therapy (CAT)

Cognitive analytic therapy is a psychological treatment for BED where a therapist works with binge eaters to assist them to make constructive alterations in their lives, and improve their well-being. CAT therapy involves investigations of involuntary motivations that lead to binge eating. [8]

Cognitive behavioral therapy (CBT) - (CBT-BED) is an adapted form of CBT

Cognitive behaviour therapy (CBT) is a psychological therapy that is structured to assist individuals make connections between their thoughts, feelings, actions, their present or past symptoms and to re-examine their views and beliefs. CBT may assist individuals to manage with problems that can activate binge-eating episodes, like negative feelings about self or depression. It can also help you to control your behavior and normalize your eating patterns. [8,9]

CBT ought to incorporate at least one of the following:

(1) Examination of thoughts, feelings or behaviour regarding BED symptom;

(2) Being assisted to make use of various ways of dealing with the symptom;

(3) Stress reduction

Interpersonal psychotherapy (IPT)

Interpersonal psychotherapy (IPT) is a form of therapy that centers on helping you to identify and tackle your relationships problems with other people. The purpose is to perk up your interpersonal skills which include the way to relate with people like family members, friends and colleagues. This may minimize binge eating that's set off by poor relationships and bad communication skills. [8, 9]

Dialectical behaviour therapy (DBT):

This is a psychological therapy that can assist binge eaters to learn behavioral skills to assist them to cope with stress, normalize their emotions and boost their relationships with others, all of which in turn curb the urge to binge eat. This is a composite and rigorous psychological treatment that was formally structured for individuals with borderline personality disorder but a simplified and modified version has been created for patients of Binge eating disorder.  It basically involves steps that help binge eater to boost their ability to control their emotions and normally carried out through 20 group sessions of two hours every week.  [8]

What to expect from a BED counselor or psychotherapist

There is currently no legislation that specifies the level of training a counselor or therapist must have before treating people with BED. Nevertheless, the National Institute for Health and Care Excellence has formulated a collection of clinical guidelines that provides advice on the forms of psychological treatment, medication and services available BED. [9]

Steps taken by therapists to help binger eaters recover

Step 1:

It is highly essential to start the treatment well. This is especially so because research found that the degree of success attained early in treatment is a great indication of how successful the whole treatment would be. [10]. This first step of intensive treatment is structured to achieve first therapeutic impetus and is composed of roughly 8 sessions conducted two times every 4 weeks. This first treatment step is aims to obtain a custom-made formulation using the individuals’ specific case to offer instruction about the treatment and the disorder, and to initiate and execute two significant processes: mutual “weekly weight checking” and “standard eating.” The improvements recorded in this first stage of treatment form the bases on which other alterations are structured. [11]

Step 2:

This step is succinct but very significant. It is an intermediary stage that is commonly completed through two appointments once a week for two weeks. At this stage, you continue with what you were introduce into in the first step and most importantly evaluate with your therapist how far you have done so far. The main intention is to discover issues that still need to be attended to as well as discover anything that is posing impediment to change.

Given the result of the assessment, a revision of the formulated treatment procedure may be introduced if deemed essential. At this stage, the treatment plan of stage three is structured. The assessment is aimed to achieve different intentions. If the assessment shows that the patients are improving, they are commended and further reinforced to make more positive changes.  If the opposite is the case, the reason for the poor performance should be understood and handled. If the reason for poor performance is any of the following; clinical perfectionism, low self-esteem or relationship difficulties, it shows that the individual needs a more extensive treatment version. [11]

Step 3:

This step is the most essential part of the treatment. The purpose of this step of treatment is to tackle what is causing the individual to engage in binge eating disorder. The method to be used and the order of tackling these issues depend on the part played by that factor in sustaining the psychopathology of the patient. It is commonly completed within 8 weeks sessions. [12, 11]

The following are issues that are usually addressed in step 3:

·        Boosting the significance of other area s for self-appraisal

·        Tackling body inspection and evasion

·        Tackling the feeling of fatness

·        Investigating the origins of overvaluation

·        Tackling Dietary regulations

·        Handling event-depended alterations in eating pattern

·        Dealing with the issues of Clinical Perfectionism, Low Self-esteem, and Interpersonal issues [13]

o   Dealing with clinical perfectionism-The psychopathology of clinical perfectionism is related to that of eating disorder.[14]

o   Tackling of issues that relate to low self-esteem

o   Taking care of what is causing interpersonal issues to the patient. [11]

 

Step four:

This is the last step that your therapist will take. It endures that your treatment is conclusive. At this stage the main focus is to ensure that the successes that have been made during the course of the treatment are maintained to minimize the possibility of the patient going back to the old habit. It basically involves three appointments roughly two weeks spaced out. At this stage, the patient is encouraged to stop monitoring the self and start weighing at home in preparation for the termination of the treatment.

To increase the possibility of the patient maintaining the habit cultivated during the training period, the therapist and patient mutually formulated a customized structure to be followed by the patient in the subsequent few months till when the patient will return for a post treatment assessment which normally fall within 20 weeks after the treatment or more.

Basically, this appointment involves re-checking of the patient’s body, training for food avoidance, and maybe additional training on problem solving. Additionally, patients are advised to keep up with their efforts to create fresh interests and activities. [11]