4 medications for binge eating disorder

Healthcare professionals characterize binge eating disorder (BED) as eating a large amount of food, often very quickly, in a short amount of time. Individuals may feel they cannot manage their eating behavior during this period.

BED can be challenging to live with and can cause physical, behavioral, and emotional symptoms. Seeking appropriate professional support can help manage the condition. 

Common treatments include psychotherapy and nutritional counseling. Certain medications can also help manage BED. Examples of drugs a doctor may prescribe include the following:

Lisdexamfetamine

Healthcare professionals typically prescribe lisdexamfetamine (Vyvanse) to treat attention deficit hyperactivity disorder (ADHD). It’s also the first medication the Food and Drug Administration (FDA) has approved to manage BED in adults.

The Vyvanse prescribing information (PI) states that the exact mechanism of action for BED management is unknown, though it’s likely related to the central nervous system (CNS). 

A 2016 article explains that the medication converts to dextroamphetamine in the body. Dextroamphetamine is a CNS stimulant that blocks the reabsorption of brain chemicals like norepinephrine and dopamine. Both norepinephrine and dopamine help regulate eating behavior and feelings of reward. In turn, this may help to reduce the urge to binge eat. 

Vyvanse is available in the form of capsules or chewable tablets. Dosage instructions in the PI recommend starting with 30 milligrams (mg) per day for about a week, then gradually increasing the dosage until you reach 50–70 mg per day. However, it’s important to follow the recommendations of your healthcare professional. 

Lisdexamfetamine side effects can include:

• dry mouth
• decreased appetite
• insomnia 
• increased heart rate
• feeling jittery 
• constipation or diarrhea
• weight loss 

There is also a risk of serious complications, especially if you take lisdexamfetamine with other medications or have any health conditions. This is why it is important to speak with a doctor before taking any other medications during treatment with lisdexamfetamine.

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Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are antidepressants. Although they are not FDA-approved to treat BED, some doctors may prescribe them for this purpose. This is called off-label prescribing. 

SSRIs are available in several forms, such as oral capsules, tablets, or liquid solutions. 

SSRIs include:

• fluoxetine (Prozac) 
• sertraline (Zoloft) 
• citalopram (Celexa)
• fluvoxamine (Luvox)

Reviews from 2016 and 2021 suggest that SSRIs can reduce the frequency of binge eating episodes. 

Although, how they treat eating disorders remains unknown. The reviews suggest it might be related to improved impulse control and regulation of serotonin levels in the brain, which can influence mood and appetite management.

The dosage of SSRIs for BED depends on the individual. For reference, the 2021 review observed BED improvements with 20–60 mg per day of fluoxetine.

Possible side effects of SSRIs can include:

• nausea
• insomnia
• headache
• reduced sex drive
• drowsiness

Topiramate

Like SSRIs, topiramate (Topamax) is not FDA-approved to treat BED, but some doctors prescribe it for this purpose. Topiramate is an anticonvulsant medication used to manage epilepsy. It is available in capsule, tablet, and liquid forms. 

A 2021 review explains that topiramate affects several neurotransmitter systems in the brain involved with appetite and weight regulation. It may support BED treatment by reducing the urge to binge eat, lowering appetite, improving impulse control, and promoting weight loss. 

In the review, dosages of 100–300 mg per day were suggested to be effective.

The review notes that topiramate can cause side effects like:

• fatigue and weakness
• memory and learning issues
• confusion
• reduced concentration

Naltrexone/bupropion combination

The naltrexone/bupropion combination (Contrave) is another medication that is not FDA-approved for BED management. However, emerging research suggests it can help. It’s an antidepressant that’s also approved to treat obesity. Naltrexone/bupropion is available as an oral tablet. 

Randomized controlled trials from 2022 and 2023 found naltrexone/bupropion reduced binge eating and promoted weight loss. It appeared especially effective when paired with therapy.

The researchers suggest it may work for BED because naltrexone reduces the rewarding effects of food, while bupropion reduces cravings. The medication may especially target leptin, the hormone that helps regulate appetite, metabolism, and fat storage.

Both studies used dosages of 32 mg per day of naltrexone and 360 mg per day of bupropion, split into smaller tablets taken twice per day. Before reaching this daily amount, the study participants took smaller doses, gradually increasing them weekly.

A 2016 article lists these possible side effects:

• nausea and vomiting
• constipation or diarrhea
• headache
• dizziness
• insomnia
• dry mouth 
• changes in blood pressure and heart rate

Other treatment options for binge eating disorder

The National Eating Disorders Association (NEDA) suggests different therapy options to manage BED, such as:

• Cognitive behavioral therapy: Helps you identify triggers for binge eating and develop coping strategies.
• Dialectical behavior therapy: Teaches how to regulate behaviors through initiatives like mindfulness, emotion regulation, and building distress tolerance.
• Interpersonal psychotherapy: Focuses on improving interpersonal relationships, which can help reduce the emotional triggers of binge eating.
• Acceptance and commitment therapy: Aims to change actions rather than thoughts and feelings.

Working with a peer support group or a registered dietitian can also help. 

When should you speak with a doctor?

If you or someone you care for is experiencing symptoms of BED, it may help to talk with a doctor for tailored advice. According to NEDA, the following symptoms may need a doctor’s attention:

• recurring binge eating episodes
• negative feelings about yourself, like depression, guilt, or disgust 
• negative impact on daily life
• co-occurring mental health conditions
• physical symptoms, such as weight changes, stomach pain, or changes to blood pressure or heart rate

It can also be helpful to speak with a doctor to learn more about therapy, medication, or other treatment options for BED. 

Summary

Several treatment options can help alleviate symptoms of BED. They include medications such as:

• SSRIs
• topiramate
• naltrexone/bupropion combination
• lisdexamfetamine

Medications may be most effective when taken alongside other treatment options, such as therapy. 

If you’re preoccupied with food or your weight, feel guilt about food choices, or follow restrictive diets, consider reaching out for support. These behaviors may indicate a disordered relationship with food or an eating disorder.

Disordered eating and eating disorders can affect anyone, regardless of gender identity, race, age, socioeconomic status, or other identities.

There are several ways you can get support. You can consider:

• speaking with a healthcare professional
• contacting the National Alliance for Eating Disorders, which offers a daytime helpline staffed by licensed therapists and an online search tool for treatment options
• accessing general mental health support by calling the Substance Abuse and Mental Health Services Administration 24 hours a day at 800-662-4357 (TTY: 800-487-4889)