Medications to Treat Binge Eating Disorder

Introduction:

Food is an important aspect of our lifestyle. Every living being needs food to survive. Food is the source of energy, nutrients, and minerals. In animals or birds, the physiologic response to having food is mediated by the hunger response. The hunger response is regulated by several factors, such as physiological, behavioral, and cognitive responses. Impairment in these processes leads to abnormal hunger patterns. Binge eating disorder is one such abnormal food habit.

What Is the Physiology of Hunger?

As discussed, physiological, psychological, and behavioral responses are responsible for regulating hunger and eating habits. The satiety cascade proposed by Bundell et al. is the physiological process that controls hunger regulation. After consuming a meal, the experience of satiation is influenced by factors such as the proportion of the meal, the quality of the food, and the satisfaction derived from eating. The distention of the stomach after eating provides information about its fullness. According to this pathway, the feeling of hunger originates from the stomach when it is empty and is passed onto the brain via the vagus nerve. Hormones like ghrelin and metabolic factors like low blood sugar levels (hypoglycemia) are also responsible for sending hunger signals to the brain. The state of satiety marks the end of the meal processing and the absorption of nutrients, while hunger initiates the next phase of eating. Sensory and cognitive responses play a crucial role in controlling meal anticipation patterns and the pleasure associated with food and eating. Hormones like GLP-1 (glucagon-like peptide-1), cholecystokinin (CCK), and PYY (peptide YY) regulate medium-term satiety by providing information about the movement of food through various parts of the digestive tract. Post-absorptive information is regulated by hormones like insulin and glucagon, as well as the concentration of amino acids and the oxidation of nutrients in the liver. The hypothalamus and brainstem are areas in the brain that process all these signals and regulate hunger signaling.

What Is Binge Eating Disorder?

Binge eating disorder (BED) is considered a mental, psychological disorder associated with eating. According to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is related to various psychological and non-psychological issues. The characteristics features are;

1. Consumption of a relatively larger amount of food than other persons would be able to consume in similar circumstances with similar physical conditions and similar periods (usually within two hours).

2. Lack of control during eating and often consumption of excessive amounts of food. Such incidents are generally seen every week, or at least once a week for three months.

The potential risk factors associated with this condition are psychological disorders like stress and anxiety and systemic disorders like obesity, diabetes, hypertension, and chronic pain. In most cases, it is seen in obese people. Around 79 percent of people suffering from binge eating disorder also suffer from psychiatric disorders. Also, 49 percent of people suffering from this condition suffer from comorbid conditions discussed above. The causative factors associated with this are;

1. Childhood Obesity: It is characterized by the presence of an excessive amount of body fat in the child’s body. It is often associated with bad food habits, childhood trauma, and dietary factors.

2. Physical and Sexual Abuse: Around 30 persons suffering from physical and sexual abuse also suffer from binge eating disorder.

3. Substance Abuse: Substance abuse like alcoholism and drug addiction is responsible for poor neural activity, which leads to impairment in the hunger sensations.

4. Perfectionism: This is a psychological disorder characterized by setting too high aspirations for oneself. People who suffer from such conditions often complain of binge eating disorders.

The primary treatment options used for such patients are counseling, cognitive behavioral therapy, and interpersonal psychotherapy.

What Are the Role of Medications in Binge Eating Disorders?

Pharmacological treatment options for binge eating disorder should only be taken into consideration if other treatment options fail. Needless to say, this is not the first line of treatment option in this case. Also, persons who do not want to receive psychotherapy need pharmacology to treat such conditions. Such drugs are;

1. Lisdexamfetamine: This is a drug approved by the Food and Drug Administration to treat such conditions. This is a central nervous system stimulant that is primarily used for the treatment of attention deficit hyperactivity disorder (ADHD) in children. This drug is a prodrug of dextroamphetamine and other amphetamines, which prevents the reuptake of neurotransmitters like norepinephrine and dopamine. This drug is known for its longer duration of action. This helps in weight loss and decreased appetite. Genetic polymorphisms associated with abnormal dopaminergic signaling are often associated with binge eating disorder. As this drug acts on dopamine and its receptors, it is beneficial in such genetic abnormalities.

2. Methylphenidate: This is another central nervous system stimulant drug that can be used for treating binge eating disorder. This drug is mainly used for treating daytime sleeping disorders and attention deficit hyperactivity disorder (ADHD).

3. Antidepressants: Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) can be used in some cases. Drugs like Fluoxetine, Fluvoxamine, Escitalopram, and Citalopram act on the 5-HT receptors and regulate the level of neuropeptide Y (an amino acid peptide that is involved in various physiological processes). However, weight gain and depression are often associated with such drugs.

4. Opioid Receptor Antagonists: Drugs like Naloxone and Naltrexone help control appetite. These drugs are often combined with antidepressants like Bupropion to combat obesity.

5. GABA and Glutamate Acting Drugs: Anti-epileptic drugs such as Acamprosate and Topiramate, which use anticonvulsant action, are effective in this type of eating disorder. Acamprosate, which is a glutamate receptor modulator, also prevents alcohol dependency. These drugs are also helpful in weight loss and controlling obesity.

6. Chromium Picolinate: This is a type of nutritional supplement that is used mainly in type II diabetes patients. This is effective in persons who suffer from metabolic disorders or can be helpful in modulating glycemia to reduce the increased risk of developing abnormal glucose metabolism.

Conclusion:

Binge eating disorder is a type of eating disorder associated with psychological problems. It is associated with excessive food consumption. Stress, depression, childhood trauma, and physical abuse are often considered risk factors. Counseling and psychotherapy is the first line of treatment in such cases. However, drugs like antidepressants and opioid antagonists can also be used to treat such conditions.