In the Journals

Evidence supports use of CBT, some medications for treatment of binge-eating disorder

Researchers found that therapist-led cognitive behavioral therapy and several drugs were effective treatment options for binge-eating disorder, according to findings published in the Annals of Internal Medicine.

Kimberly A. Brownley, PhD, from the department of psychiatry at the University of North Carolina, and colleagues found that other forms of CBT and another drug demonstrated some efficacy as well.

They noted that while binge-eating disorder is the most common eating disorder, affecting about 3% of adults in the United States, guidelines from the American Psychiatric Association and the National Institute for Health and Care Excellence were not in agreement.

"Treatment aims to reduce binge-eating frequency and disordered eating-related cognitions, improve metabolic health and weight (in patients who are obese, diabetic, or both), and regulate mood (in patients with coexisting depression or anxiety)," the researchers wrote. "Treatment approaches include psychological and behavioral treatments, pharmacologic treatments, and combinations of the two approaches."

Brownley and colleagues conducted a systematic review and meta-analysis of 34 randomized trials that assessed pharmacologic, psychological or combination treatment.

Results showed that therapist-led CBT (RR = 4.95; 95% CI, 3.06-8), lisdexamfetamine (RR = 2.61; 95% CI, 2.04-3.33), and second-generation antidepressants (RR = 1.67; 95% CI, 1.24-2.26), increased binge-eating abstinence and decreased frequency. In addition, second-generation antidepressants (mean difference = –.3.84; 95% CI, –6.55 to –1.13), and lisdexamfetamine (mean difference = –6.5; 95% CI, –8.82 to –4.18) reduced eating-related compulsions and obsessions. Second-generation antidepressants also reduced depression symptoms (mean difference = –1.97; 95% CI, –3.67 to –0.28).

Further, other forms of CBT and topiramate increased binge-eating abstinence and frequency. Topiramate also increased sympathetic nervous system arousal and reduced weight, while lisdexamfetamine reduced both appetite and weight.

"Among adults with [binge-eating disorder], strong evidence indicates that therapist-led CBT, lisdexamfetamine, and [second-generation antidepressants] as a general class (mainly selective serotonin reuptake inhibitors) reduce the frequency of binge eating, increase the likelihood of achieving abstinence from binge eating, and improve other eating-related psychological outcomes," Brownley and colleagues wrote. "Similar but less compelling evidence shows a benefit from other forms of CBT and topiramate."

They noted that harms associated with these treatments rarely impacted the treatments.

"It is unclear whether these findings generalize to patients with [binge-eating disorders] beyond those included in these trials (chiefly, overweight or obese 20- to 40-year-old white women without psychological or medical comorbidity). Adequately powered trials are needed to evaluate the comparative long-term benefits of psychological and pharmacologic treatments." – by Chelsea Frajerman Pardes

Disclosures: Brownley reports grants from the Agency for Healthcare Research and Quality during the conduct of the study and personal fees from Shire and Sunovion Pharmaceuticals outside the submitted work. Please see the full study for a list of all other authors' relevant financial disclosures.

Researchers found that therapist-led cognitive behavioral therapy and several drugs were effective treatment options for binge-eating disorder, according to findings published in the Annals of Internal Medicine.

Kimberly A. Brownley, PhD, from the department of psychiatry at the University of North Carolina, and colleagues found that other forms of CBT and another drug demonstrated some efficacy as well.

They noted that while binge-eating disorder is the most common eating disorder, affecting about 3% of adults in the United States, guidelines from the American Psychiatric Association and the National Institute for Health and Care Excellence were not in agreement.

"Treatment aims to reduce binge-eating frequency and disordered eating-related cognitions, improve metabolic health and weight (in patients who are obese, diabetic, or both), and regulate mood (in patients with coexisting depression or anxiety)," the researchers wrote. "Treatment approaches include psychological and behavioral treatments, pharmacologic treatments, and combinations of the two approaches."

Brownley and colleagues conducted a systematic review and meta-analysis of 34 randomized trials that assessed pharmacologic, psychological or combination treatment.

Results showed that therapist-led CBT (RR = 4.95; 95% CI, 3.06-8), lisdexamfetamine (RR = 2.61; 95% CI, 2.04-3.33), and second-generation antidepressants (RR = 1.67; 95% CI, 1.24-2.26), increased binge-eating abstinence and decreased frequency. In addition, second-generation antidepressants (mean difference = –.3.84; 95% CI, –6.55 to –1.13), and lisdexamfetamine (mean difference = –6.5; 95% CI, –8.82 to –4.18) reduced eating-related compulsions and obsessions. Second-generation antidepressants also reduced depression symptoms (mean difference = –1.97; 95% CI, –3.67 to –0.28).

Further, other forms of CBT and topiramate increased binge-eating abstinence and frequency. Topiramate also increased sympathetic nervous system arousal and reduced weight, while lisdexamfetamine reduced both appetite and weight.

"Among adults with [binge-eating disorder], strong evidence indicates that therapist-led CBT, lisdexamfetamine, and [second-generation antidepressants] as a general class (mainly selective serotonin reuptake inhibitors) reduce the frequency of binge eating, increase the likelihood of achieving abstinence from binge eating, and improve other eating-related psychological outcomes," Brownley and colleagues wrote. "Similar but less compelling evidence shows a benefit from other forms of CBT and topiramate."

They noted that harms associated with these treatments rarely impacted the treatments.

"It is unclear whether these findings generalize to patients with [binge-eating disorders] beyond those included in these trials (chiefly, overweight or obese 20- to 40-year-old white women without psychological or medical comorbidity). Adequately powered trials are needed to evaluate the comparative long-term benefits of psychological and pharmacologic treatments." – by Chelsea Frajerman Pardes

Disclosures: Brownley reports grants from the Agency for Healthcare Research and Quality during the conduct of the study and personal fees from Shire and Sunovion Pharmaceuticals outside the submitted work. Please see the full study for a list of all other authors' relevant financial disclosures.