Medications for Binge Eating Disorder

First-Line Treatment Approach

The American Psychiatric Association recommends psychotherapy as the initial treatment for binge eating disorder (BED), specifically eating disorder-focused cognitive-behavioral therapy (CBT) or interpersonal therapy in either individual or group formats 1, 2
Medications should be considered when patients prefer medication over psychotherapy 3 or have not responded adequately to psychotherapy alone 4

Lisdexamfetamine dosing typically follows titration protocol to minimize side effects, as recommended by the Clinical Gastroenterology and Hepatology guidelines 5
Topiramate, an anticonvulsant, has evidence for reducing binge eating behaviors and is often used as part of combination therapy (e.g., phentermine/topiramate ER), according to the Clinical Gastroenterology and Hepatology guidelines 5
Naltrexone/Bupropion (Contrave) has evidence for weight management and is particularly useful for patients who describe food cravings or addictive eating behaviors, as stated in the Clinical Gastroenterology and Hepatology and Gastroenterology guidelines 5, 6, 7

The Gastroenterology guidelines suggest considering lisdexamfetamine, topiramate, or naltrexone/bupropion for patients with comorbid obesity 5, 7
Naltrexone/bupropion may benefit patients with comorbid depression or those trying to quit smoking, according to the Gastroenterology guidelines 7

The Gastroenterology guidelines recommend avoiding weight gain-inducing medications, such as mirtazapine and tricyclic antidepressants, in BED patients with obesity 7
The Clinical Gastroenterology and Hepatology guidelines suggest monitoring for side effects and adjusting dosing as needed for long-term treatment 5

The American Gastroenterological Association recommends topiramate as part of combination therapy (phentermine/topiramate ER) for reducing binge eating behaviors and body weight in BED, although this combination is FDA-approved only for obesity, not BED specifically 8, 9, 10
The mechanism of topiramate involves modulation of GABA receptors, carbonic anhydrase inhibition, and glutamate antagonism to reduce appetite and increase satiation, making it a useful option for patients with obesity alongside BED 8
Naltrexone/bupropion (Contrave) is particularly beneficial for patients describing food cravings or addictive eating patterns, and works synergistically by activating POMC neurons in the arcuate nucleus, releasing alpha-melanocyte-stimulating hormone 8, 9, 10

The American College of Gastroenterology recommends assessing efficacy and safety monthly for the first 3 months, then at least every 3 months, and discontinuing medication if ≤5% weight loss at 12 weeks 9, 10
Medications should be used as adjuncts to lifestyle modifications, not as monotherapy, as recommended by the American Gastroenterological Association 9, 10

Psychotherapy, specifically eating disorder-focused cognitive-behavioral therapy (CBT) or interpersonal therapy, is the recommended first-line treatment for binge eating disorder, not medication, according to the American Journal of Psychiatry 11

Lisdexamfetamine (50-70 mg/day) is the only FDA-approved medication and represents the first-line pharmacologic option for moderate-to-severe binge eating disorder, especially when weight management is a goal 11

The American College of Gastroenterology recommends assessing efficacy and safety monthly for the first 3 months, then at least every 3 months, and discontinuing medication if ≤5% weight loss at 12 weeks 11