Two Antidepressants Effective for Binge-Eating Disorder

From the WebMD Archives

Dec. 2, 1999 (New York) -- Up to 1 million people in the United States suffer from binge-eating disorders, going through episodes where they feel the compulsive need to eat, to stuff themselves. Afterward, they're often left feeling out of control, ashamed, depressed, and obese. Professional care is usually needed to break the cycle, but to date there are no standard treatment programs for this specific eating disorder. Now, there is more evidence that some common antidepressants may help.

Many doctors believe that eating disorders share a common biological link with other conditions such as depression and anxiety, which if true would mean similar treatments could be effective. For some people, depression and anxiety can be controlled by taking such antidepressants as Luvox (fluvoxamine) or Zoloft (sertraline). They belong to a class of drugs called selective serotonin reuptake inhibitors (SSRIs), which put more serotonin, a mood-regulating chemical, into the body.

A recent presentation at the Eating Disorders Research Society Annual Meeting in San Diego detailed two studies in which people with binge-eating disorder responded favorably to the two medications. Both drugs led to overall improvement when compared with a placebo.

"Over the last decade or two, the eating-disorder community has recognized that there are groups of people who engage in compulsive bingeing behavior ... but don't engage in the purging behavior that is characteristic of bulimia nervosa. ... [Binge-eating disorder] is associated with lots of symptoms of depression and anxiety. ... It is certainly abnormal, very troublesome, and is associated with mental health problems," researcher James I. Hudson, MD, tells WebMD. Hudson was involved in one of the studies; he is the associate chief of biological psychiatry at McLean Hospital in Boston and is also affiliated with Harvard Medical School.

Since SSRIs have been useful for bulimia, Hudson says that it was a natural extension to see if these types of medications could also work for binge-eating disorders.

Sharon Alger-Mayer, MD, with the obesity and eating disorder program at Albany Medical College in New York, believes that the results support a chemical link between eating disorders and anxiety and depression.

"Since the 1970s, people have recognized that the same substances that control mood also control appetite. If there's a low level of serotonin, one may feel depressed but also crave high-carbohydrate, binge-type foods. Consuming high-carbohydrate foods results in increased production of brain serotonin. Thus, the body may be self-medicating by bingeing. ... You might feel better for a short time, but then you feel guilty about bingeing and the whole process repeats. That's why using a drug to increase serotonin levels might suppress the desire to binge."

"I'm not surprised by the findings," Dirk Miller, PhD, tells WebMD. "It's not radically new to suggest that someone with [the disorder] will respond favorably to SSRIs. In practice, clinicians are using them all the time. It's confirming the idea that SSRIs are useful for the treatment of eating disorders -- but they're not the effective treatment for them," says Miller, a psychologist with the Emily Program in St. Paul, Minn., an outpatient eating-disorders program.

"Like all eating disorders, [binge eating] is a pesky problem which is extremely difficult to treat. I think talk therapy would always be the first choice for treating eating disorders," says Miller.

Alger-Mayer agrees that the idea of using SSRIs for binge eating is not new, but says that most of the data to date have focused on Prozac (fluoxetine), which is another SSRI. "This is great data to know. It's new information for these particular drugs," she says. Although she prescribes Prozac if a patient can tolerate it, Alger-Mayer would choose another SSRI if the patient has anxiety or there is another reason not to use it.