Binge eating disorder: updated overview for primary care practitioners.

OBJECTIVE: To provide an updated overview of binge eating disorder (BED) that includes recommendations relevant for primary care practitioners. QUALITY OF EVIDENCE: PubMed, Google Scholar, and PsycInfo were searched with no time restriction using the subject headings binge eating disorder, treatment, review, guidelines, psychotherapy, primary care, and pharmacotherapy. Levels of evidence for all treatment recommendations ranged from I to III. MAIN MESSAGE: Binge eating disorder is associated with considerable patient distress and impairment, as well as medical and psychiatric comorbidities, and was added to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, in 2013. Primary care practitioners are well suited to screen, diagnose, and initiate treatment for BED. A stepped-care approach to treatment starts with guided self-help, adding or moving to pharmacotherapy or individual psychotherapy as needed. The psychotherapies with the most research support include cognitive behaviour therapy, interpersonal therapy, and dialectical behaviour therapy. In terms of pharmacotherapy, evidence supports the use of lisdexamfetamine, antidepressant medications, and anticonvulsant medications. CONCLUSION: This overview provides guidance on screening, diagnosis, and treatment approaches based on the currently available evidence, as well as expert opinions of a diverse group of experts to help guide clinicians where evidence is limited

Secondary outcomes and qualitative findings of an open-label feasibility trial of lisdexamfetamine dimesylate for adults with bulimia nervosa

Abstract Background There is emerging evidence that stimulants warrant further investigation as a treatment for bulimia nervosa (BN) including a recent open-label feasibility trial examining the use of lisdexamfetamine dimestylate (LDX) for BN. The current report presents the secondary outcomes and qualitative interview results from that feasibility trial. These outcomes explore several purported mechanisms that may explain how stimulants affect symptoms of BN: appetite, impulsivity, obsessive and compulsive symptoms, eating disorder psychopathology/impairment and reward-based decision-making. Methods Twenty-three participants with BN received LDX for eight weeks. Questionnaires assessing appetite, impulsivity, obsessive and compulsive symptoms, eating disorder psychopathology and impairment were administered at baseline and post-treatment. Participants also completed a two-step reinforcement learning task to assess their decision-making. Semi-structured interviews took place at baseline, week 5, and follow-up. Results Reductions in hunger, food-related impulsivity, obsessive and compulsive features, eating disorder psychopathology and impairment were found. However, reward learning, as far as it is assessed by the task, did not seem to contribute to the effect of LDX on BN symptoms. Qualitative analysis suggested four themes: (1) reprieve from the eating disorder, (2) improvement in function and quality of life, (3) renewed hope for recovery, and (4) ability to normalize eating. Conclusions This report suggests several potential mechanisms by which LDX may reduce symptoms of binging and purging in those with BN. Importantly, due to the open-label design, we are unable to attribute findings to the medication. Instead, our results should be interpreted as hypothesis generating to inform future studies such as adequately powered randomized controlled trials. Trial registration NCT03397446

The potential role of stimulants in treating eating disorders

Background: Many individuals with eating disorders remain symptomatic after a course of psychotherapy and pharmacotherapy; therefore, the development of innovative treatments is essential. Method: To learn more about the current evidence for treating eating disorders with stimulants, we searched for original articles and reviews published up to April 29, 2021 in PubMed and MEDLINE using the following search terms: eating disorders, anorexia, bulimia, binge eating, stimulants, amphetamine, lisdexamfetamine, methylphenidate, and phentermine. Results: We propose that stimulant medications represent a novel avenue for future research based on the following: (a) the relationship between eating disorders and attention deficit/hyperactivity disorder (ADHD); (b) a neurobiological rationale; and (c) the current (but limited) evidence for stimulants as treatments for some eating disorders. Despite the possible benefits of such medications, there are also risks to consider such as medication misuse, adverse cardiovascular events, and reduction of appetite and pathological weight loss. With those risks in mind, we propose several directions for future research including: (a) randomized controlled trials to study stimulant treatment in those with bulimia nervosa (with guidance on strategies to mitigate risk); (b) examining stimulant treatment in conjunction with psychotherapy; (c) investigating the impact of stimulants on “loss of control” eating in youth with ADHD; and (d) exploring relevant neurobiological mechanisms. We also propose specific directions for exploring mediators and moderators in future clinical trials. Discussion: Although this line of investigation may be viewed as controversial by some in the field, we believe that the topic warrants careful consideration for future research