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Pharmacological Approaches to the Management of Binge Eating Disorder

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Abstract

In the USA, binge eating disorder (BED) is the most common eating disorder, with a lifetime prevalence of ~3.5 % in adult women, 2.0 % in adult men, and 1.6 % in adolescents. BED is characterized by frequent episodes of binge eating that are accompanied by a sense of loss of control over eating and result in marked psychological distress. BED is highly co-morbid with obesity and with depression and other psychiatric conditions, and it is associated with substantial role impairment. Currently, there are no US FDA-approved pharmacological treatments for BED. Animal and human studies implicate underlying dysregulation in dopamine, opioid, acetylcholine, and serotonin neurocircuitry within brain reward regions in the pathogenesis and maintenance of BED. To date, the efficacy of various agents that target these and other neurotransmitter systems involved in motivated feeding behavior, mood regulation, and impulse control have been investigated in the treatment of BED. Several antidepressant and anticonvulsant agents have demonstrated efficacy in reducing binge eating frequency, but only in limited cases have these effects resulted in patients achieving abstinence, which is the primary goal of treatment; they also range from less (fluvoxamine) to more (topiramate) effective in achieving weight loss that is both clinically meaningful and significantly greater than placebo. Collectively, the literature on pharmacological treatment approaches to BED is limited in that very few agents have been studied in multiple, confirmatory trials with adequate follow up, and almost none have been evaluated in large patient samples that are diverse with respect to age, sex, and ethnicity. In addition, prior trials have not adequately addressed, through study design, the high placebo response commonly observed in this patient population. Several novel agents are in various phases of testing, and recent animal studies focusing on glutamate-signaling circuits linking the amygdala to the lateral hypothalamus offer new avenues for exploration and potential therapeutic development. Studies of newly FDA-approved medications for long-term obesity treatment and further explorations of dietary supplements and neutraceuticals with appetite- and mood-altering properties may also be worthwhile.

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Acknowledgments

Drs. Brownley, Peat, and Bulik have received funding from the Agency for Healthcare Research and Quality (AHRQ) for conducting a systematic review of treatment and outcomes in binge eating disorder. None of these funds were used in the preparation of this manuscript. Dr. Bulik is a consultant and contract recipient for Shire Pharmaceuticals. Drs. Brownley and Peat have been consultants for Shire Pharmaceuticals. Dr. La Via reports no conflicts of interest.

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Authors and Affiliations

  1. Department of Psychiatry, CB #7175, University of North Carolina, Chapel Hill, NC, 27599-7175, USA

    Kimberly A. Brownley, Christine M. Peat, Maria La Via & Cynthia M. Bulik

  2. Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA

    Cynthia M. Bulik

  3. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden

    Cynthia M. Bulik

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  1. Kimberly A. Brownley
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Correspondence to Kimberly A. Brownley.

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Brownley, K.A., Peat, C.M., La Via, M. et al. Pharmacological Approaches to the Management of Binge Eating Disorder. Drugs 75, 9–32 (2015). https://doi.org/10.1007/s40265-014-0327-0

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