An ADHD drug may tame binge eating disorder

A pill may help those whose out-of-control eating is a cause of extreme distress

Binge eating disorder, a newly recognized condition in which bouts of voracious eating lead to guilt, shame and often obesity, may yield to lisdexamfetamine (marketed as Vyvanse), a medication that has been used for several years to treat attention deficit and hyperactivity disorder in children and adults.

In an 11-week clinical trial that tested a range of Vyvanse dosages, researchers found that, compared to those taking a placebo pill, subjects diagnosed with binge eating disorder who took a daily 50 or 70 mg dose of the ADHD drug had fewer binge eating episodes, were more likely to cease binge eating for a four-week period, reported greater improvement in their functioning, and lost substantially more weight.

The findings, published online early in the journal JAMA Psychiatry on Wednesday, offer early evidence that patients whose consumption patterns are punctuated by episodes of out-of-control eating may be helped by some medication. The disorder, which has in recent years won wider recognition by the psychiatric establishment, has traditionally been treated with psychotherapy. It has proved a difficult condition to treat.

Among those getting lisdexamfetamine, side effects were similar to those experienced by adults who take the medication to treat symptoms of ADHD, including dry mouth, difficulty falling asleep, increased heart rate and headaches. Adverse events prompted six of 196 subjects in the active arm of treatment to withdraw from the study.

The study offers preliminary hope that medication could help those whose binge-eating has led to shame, social withdrawal and weight problems. But its findings were limited by the fact that researchers excluded from the subject population any binge-eaters who suffer from other psychiatric conditions.

Roughly half of those suffering binge-eating disorder will also be diagnosed with depression at some point in their lives. And the food obsession and compulsive eating behavior that are hallmarks of the diagnosis have led some psychiatrists to suggest that binge eating is a form of obsessive-compulsive disorder.

The authors of the latest study said they sought out subjects who did not suffer related psychiatric conditions in order to "limit potential confounding factors and to allow for an assessment of the effect of lisdexamfetamine specifically on [binge eating] behavior."

While subjects taking placebo medication improved markedly -- a common finding in psychiatric medications -- those taking lisdexamfetamine saw more dramatic changes in behavior. Over 11 weeks, those taking the 50 mg and 70 mg doses of lisdexamfetamine went from experiencing an average of 4.5 days a week that included some binge eating to an average of nearly none.

Subjects getting a 30 mg dose, or a placebo, went from an average of 4.5 binge-eating days a week to an average of roughly one.

Weight loss is not generally considered an outcome of treatment for binge eating, but since overweight and obesity are frequently health problems for those with binge eating, it is often considered a positive side benefit. Subjects who got the Vyvanse lost between 9 and 11 pounds, on average, while those on placebo lost none in the 11-week study period.

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