Therapist-led cognitive behavioral therapy (CBT), lisdexamfetamine, second-generation antidepressants (SGAs), and topiramate may reduce binge eating frequency and related psychopathology, according to a study published in the Annals of Internal Medicine. In addition, lisdexamfetamine and topiramate may reduce weight in adults with binge-eating disorder.
Kimberly A. Brownley, PhD, from the Department of Psychiatry at the University of North Carolina, and colleagues outlined the benefits and risks of psychological and pharmacologic treatment options for adults with binge-eating disorder.
The meta-analysis included 9 waitlist-controlled psychological trials and 25 placebo-controlled trials that evaluated pharmacologic (n=19) or combination (n=6) treatment. Two reviewers extracted the trial data, assessed risk bias, and graded the strength of the evidence. The trials included in the analysis had a low or medium risk of bias.
The researchers found that therapist-led CBT decreased binge-eating frequency and increased binge-eating abstinence (relative risk, 4.95). Lisdexamfetamine was also associated with decreased binge-eating frequency and increased binge-eating abstinence (relative risk, 2.61), along with second-generation antidepressants (relative risk, 1.67).
“Our findings provide strong support for therapist-led CBT, lisdexamfetamine, and SGAs (as a group) in helping patients with BED [binge-eating disorder] reduce binge-eating frequency and achieve abstinence; with less confidence, they suggest similar benefits from topiramate and other forms of CBT,” the study authors wrote.
The results also showed that lisdexamfetamine and second-generation antidepressants reduced compulsions related to binge eating (mean difference, -6.50 and -3.84, respectively) and second-generation antidepressants also reduced symptoms of depression (mean difference, -1.97).
Lisdexamfetamine was more frequently associated with headache, gastrointestinal upset, sleep disturbance, and sympathetic nervous system arousal compared with placebo (relative risk range, 1.63 to 4.28). Topiramate also reduced weight and increased sympathetic nervous system arousal, while lisdexamfetamine reduced weight and appetite.
“Adequately powered trials are needed to evaluate the comparative long-term benefits of psychological and pharmacologic treatments,” the authors noted. “Given the high levels of association among BED, obesity, and depression, future studies should determine whether certain treatments are better suited for particular subsets of patients.”
- Brownley KA, Berkman ND, Peat CM, et al. Binge-eating disorder in adults: A systematic review and meta-analysis. Ann Intern Med. 2016;165(6):409-420. doi: 10.7326/M15-2455.