Medication Options for Binge Eating Disorder

What Is Binge Eating Disorder?

Binge eating disorder is a type of eating disorder characterized by eating substantially large amounts of food over a short period. Many people who binge describe losing a sense of control over food, and they often experience profound shame and guilt over their eating. Unlike people with bulimia (who also binge-eat), those with binge eating disorder do not engage in compensatory behaviors after binging.

Research shows that binge eating disorder affects approximately 3% of Americans. It’s estimated that more people experience binge eating disorder than those who experience both anorexia and bulimia combined.³ Many people with this condition have body image concerns, and they may also meet the criteria for other co-occurring mental health issues, including depression, anxiety, substance use disorders, and PTSD.

Treatment for Binge Eating Disorder

Eating disorder treatment can be complex and multidisciplinary. Binge eating disorder may be treated via various evidence-based psychotherapy models, including cognitive behavioral therapy (CBT), family therapy, DBT for eating disorders, acceptance and commitment therapy (ACT), and psychodynamic therapy. Therapy may focus on understanding emotional triggers, implementing new coping skills, and improving overall self-esteem.

Treatment may also include other healthcare components, including dietitian support and coordination with other medical professionals. In moderate or severe cases, people with eating disorders may require hospitalization. This becomes more pertinent if someone is experiencing malnutrition or severe dehydration. In addition, if outpatient treatment does not sufficiently treat symptoms, someone may be referred to a higher level of partial hospitalization or inpatient care.

What Are the Best Medications for Binge Eating Disorder?

Behavioral treatments, including therapy, are often the first recommendation for treating eating disorders. However, medications for eating disorders may also be recommended to target other symptoms, improving overall mood, and regulating someone’s motivation to eat and experience satiation. As society has become more aware of the physical and emotional implications of binge eating, new medications will likely be developed to help treat this disorder.

A person with binge eating disorder may be prescribed one or a combination of these medications to combat symptoms:

Lisdexamfetamine Dimesylate (LDX)

The FDA-approved LDX (Vyvanse), a stimulant traditionally used to treat ADHD, in 2015. To date, it is the only drug solely approved for treating binge eating disorder. Research consistently shows that LDX can effectively improve binge eating symptoms compared to placebo by reducing overall food intake and changing appetite/satiety cues.⁴

Common side effects of LDX may include:

• Nausea
• Vomiting
• Gastrointestinal issues
• Sleep problems
• Faster heart rate
• Dizziness

Off-Label (Non-FDA Approved) Medications

Many people take off-label medications to treat their binge eating disorder. Off-label means using an FDA-approved medication for a different condition than what it is approved for. Healthcare professionals may prescribe medication off-label based on their professional judgment. This type of practice is typical and legal. It’s commonly used when people have already tried FDA-approved medications without achieving significant results.

Here are medications that can be prescribed off labor for the treatment of binge eating disorder:

• Xenical (orlistat)
• Qsymia (phentermine-topiramate)
• Contrave (naltrexone-bupropion)
• Victoza (liraglutide)
• Ozempic (semaglutide)
• Imcivree (setmelanotide)

Common side effects of these prescriptions may include:

• Nausea
• Constipation
• Diarrhea
• Headaches

Selective Serotonin Reuptake Inhibitors (SSRIs)

Antidepressants, including SSRIs, are often prescribed to treat bulimia. They have also been effective in treating binge eating disorder. Research shows this efficacy may speak to the co-occurring nature of binge eating and abnormalities with the neurotransmitters dopamine, serotonin, and norepinephrine. SSRIs act on these specific neurotransmitters, and they can also improve mood and emotional regulation, which may help with eating disorder symptoms.⁵

SSRIs that may be prescribed in the treatment of binge eating disorder include:

• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Some common symptoms of SSRIs include:

• Dizziness
• Dry mouth
• Fatigue
• Headache
• Insomnia
• Sexual problems
• Gastrointestinal distress

Anti-Obesity Medications

Anti-obesity medications refer to medications intended to manage or lose weight. They have become increasingly popular in recent years, although they are controversial. For instance, it’s important to remember that eating disorders are not weight disorders, and losing weight does not inherently “change” or even improve an eating disorder. However, some medications may be useful for regulating appetite, cravings for food, and overall satiety.⁶

How to Find Treatment for Binge Eating Disorder

It’s possible to initially self-diagnose yourself with binge eating disorder symptoms. However, only a healthcare professional, such as a therapist, psychiatrist, or doctor can officially diagnose an eating disorder. Your provider may use a preliminary assessment, such as the BES or BEDS-7, to specifically screen for binge eating disorder. This diagnosis is often necessary for receiving a medication prescription.

How to Prepare for a First Appointment

It can be nerve-wracking to discuss eating disorder symptoms with your doctor or healthcare professional. However, being honest allows you to get the help and relief you need. If it’s helpful, consider writing down your specific stressors and concerns ahead of time. You should expect to be asked about your current and past medical and psychiatric history as well as any other medications you are currently taking.

Here are some questions to ask at your first appointment:

• Which type of medication do you recommend for me?
• What side effects should I be aware of?
• How soon can I expect this medication to work?
• What other options do you recommend if I don’t want to take medication?
• What kind of symptom reduction should I reasonably expect?

8 Tips for Improving Treatment Success

Eating disorder recovery takes time, effort, and intention. Many people experience various lapses during their journey, and this is normal. With that, it’s important to identify and implement various eating disorder coping strategies to improve your treatment success rates. Try to learn from any mistakes you make and remember that there isn’t a “perfect” way to recover from binge eating.

Here are 8 tips for reducing the urge:

1. Practice mindful eating: Mindful eating is a component of intuitive eating, which refers to slowing down eating and being more intentional with food. This may reduce the urge to binge.
2. Aim to develop a more neutral or positive body image: Try to focus on the good things your body allows you to do. Remember that you are so much more than your physical body.
3. Avoid restricting: Restricting food often creates a scarcity effect, which can perpetuate binge cycles. Even if you do binge, don’t compensate for it by fasting or dieting the next day.
4. Distract yourself: If the urge to binge arises, try to distract yourself for at least 10-20 minutes with a non-food-related activity. This may help mitigate some of the intensity of that specific craving.
5. Seek like-minded support: Connect with other people who can support you during your recovery. Consider joining an eating disorder support group online or in person.
6. Try to avoid labeling foods as good or bad: Many people who struggle with binging label certain types of food as forbidden. This can put them on a pedestal, which may make you more likely to binge on them.
7. Practice self-soothing without food: Develop a working list of positive coping skills that don’t require eating. Consider sensory-based activities like warm baths, listening to favorite songs, or deep breathing.
8. Try to challenge diet mentality: Dieting can be insidious, and it often coincides with harmful attitudes around food and eating. Although it may be challenging, many people find that their recovery requires them to let go of diet culture.