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Role of Antiepileptic Drugs in the Management of Eating Disorders

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Abstract

Growing evidence suggests that antiepileptic drugs (AEDs) may be useful in managing some eating disorders. In the present paper, we provide a brief overview of eating disorders, the rationale for using AEDs in the treatment of these disorders and review the data supporting the effectiveness of specific AEDs in the treatment of patients with eating disorders. In addition, the potential mechanisms of action of AEDs in these conditions are discussed.

Of the available AEDs, topiramate appears to have the broadest spectrum of action as an anti-binge eating, anti-purging and weight loss agent, as demonstrated in two placebo-controlled studies in bulimia nervosa and three placebo-controlled studies in binge-eating disorder (BED) with obesity. Topiramate may also have beneficial effects in night-eating syndrome and sleep-related eating disorder, but controlled trials in these conditions are needed. The results of one small controlled study suggest that zonisamide may have efficacy in BED with obesity. However, both topiramate and zonisamide are associated with adverse effect profiles that may limit their use in patients with eating disorders. Phenytoin may be effective in some patients with compulsive binge eating, particularly if co-morbid EEG abnormalities are present, but available data are too varied to allow definitive conclusions to be made. Carbamazepine and valproate may be effective in treating patients with bulimia nervosa or anorexia nervosa when they are used to treat an associated psychiatric (e.g. mood) or neurological (e.g. seizure) disorder; otherwise, both agents, particularly valproate, are associated with weight gain.

In conclusion, AEDs have an emerging role in the management of some eating disorders.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. Dr Susan L. McElroy is a consultant to, or member of, the scientific advisory boards of Abbott Laboratories, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutica, Ortho-McNeil and Wyeth-Ayerst, and is a principal or co-investigator on research studies sponsored by Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Esai, Eli Lilly and Company, Forest Laboratories, GlaxoSmithKline, Janssen Pharmaceutica, Jazz Pharmaceuticals, Inc., National Institute of Mental Health (NIMH), Orexigen Therapeutics, Inc., Ortho-McNeil, Pfizer, Sanofi-Synthelabo, Somaxon Pharmaceuticals, Inc., Stanley Medical Research Institute and Takeda Pharmaceutical Company Ltd. She is also inventor on US Patent No. 6,323,236 B2 (McElroy SL: Use of sulfamate derivatives for treating impulse control disorders; filed 2000 Feb 18, approved 2001 Nov 27) and, along with the patent’s assignee (University of Cincinnati, Cincinnati, Ohio, USA), receives payments from Johnson & Johnson Pharmaceutical Research and Development, LLC, which has exclusive rights under the patent. Dr Paul E. Keck Jr is a principal or co-investigator on research studies sponsored by Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Eli Lilly and Company, Janssen Pharmaceutica, National Institute of Mental Health (NIMH), National Institute of Drug Abuse (NIDA), Pfizer and UCB Pharma. He has also been reimbursed for consulting to Bristol-Myers Squibb, Eli Lilly and Company, Forest Laboratories, Organon and Pfizer, and is an inventor on US Patent No. 6,387,956 (Shapira NA, Goldsmith TD, Keck Jr PE, University of Cincinnati: Methods of treating obsessive-compulsive spectrum disorder comprises the step of administering an effective amount of tramadol to an individual; filed 1999 Mar 25, approved 2002 May 14). Dr Pope has participated in studies funded by Eli Lilly, Solvay and Ortho-McNeil Pharmaceuticals. Dr Hudson has consulted for Eli Lilly, Pfizer and Ortho-McNeil Pharmaceutical, and has received research grant support from Eli Lilly, Ortho-McNeil Pharmaceutical, Ortho-McNeil Janssen Scientific Affairs and Forest Laboratories. He has also provided expert testimony in litigation involving Forest Laboratories. Dr Guerdjikova and Mr Martens have no conflicts of interest that are directly relevant to the content of this review.

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  1. Lindner Center of HOPE, 4075 Old Western Row Road, Mason, Ohio, 45050, USA

    Susan L. McElroy, Anna I. Guerdjikova, Brian Martens & Paul E. Keck Jr

  2. Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA

    Susan L. McElroy, Anna I. Guerdjikova, Brian Martens & Paul E. Keck Jr

  3. Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, USA

    Harrison G. Pope & James I. Hudson

  4. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA

    Harrison G. Pope & James I. Hudson

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  1. Susan L. McElroy
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Correspondence to Susan L. McElroy.

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McElroy, S.L., Guerdjikova, A.I., Martens, B. et al. Role of Antiepileptic Drugs in the Management of Eating Disorders. CNS Drugs 23, 139–156 (2009). https://doi.org/10.2165/00023210-200923020-00004

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