In January, the U.S. Food and Drug Administration expanded the approved uses of Vyvanse (lisdexamfetamine dimesylate) to treat binge-eating disorder in adults. The drug is the first FDA-approved medication to treat binge-eating disorder.
“Binge eating can cause serious health problems and difficulties with work, home, and social life,” said Mitchell Mathis, M.D., director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research. “The approval of Vyvanse provides physicians and patients with an effective option to help curb episodes of binge eating.”
What is Binge-Eating Disorder?
While most people have had experiences of overeating, binge-eating disorder is much different. Binge-eating disorder is a psychiatric illness in which people with experience repeated episodes of overeating. The amount of food consumed during these binge episodes varies, but could amount to several thousand calories. During these episodes, there is a loss of control, and food is sometimes consumed in a dissociative way. People with binge-eating disorder eat when they are not physically hungry to the point of being uncomfortably full.
Binge-eating disorder has many consequences. It is often a secretive disorder, and people experiencing it may have a sense of shame and isolation. It can also lead to weight gain. Not all people that engage in binging behaviors are overweight, and treatment does not focus on weight loss, but on decreasing or eliminating binge eating.
What is Vyvanse and How Does It Work?
First approved in 2007 to treat ADHD, or attention deficit hyperactivity disorder, Vyvanse is an amphetamine. It is used to help with focus in attentional disorders. When people take Vyvanse, they often experience a decrease in appetite. In terms of binge-eating disorder, proponents feel that reducing physical hunger cues will lead to increased control of food intake.
The efficacy of Vyvanse in treating binge-eating disorder was shown in two clinical studies that included 724 adults with moderate-to-severe binge-eating disorder. In the studies, participants taking Vyvanse experienced a decrease in the number of binge eating days per week and had fewer obsessive-compulsive binge eating behaviors compared to those on the inactive pill (placebo).
Side Effects of Vyvanse
While Vyvanse has shown some promise in treating binging behaviors, it is important to remember that no medication is without risks. Vyvanse is a stimulant. As an activating medication, it can increase blood pressure and heart rates. The FDA says its most serious risks include psychiatric and heart complications, including sudden death in people with heart ailments and also the risk of stroke and heart attack in adults.
Vyvanse’s approval for binge-eating disorder has come with mixed support. One critical concern is that doctors will prescribe Vyvanse as an “off label” treatment for weight loss, rather than as a way to control binging.
Chevese Turner, founder of the Binge Eating Disorder Association (BEDA), has herself struggled with binge-eating in the past. She says that BEDA does not have an official position on Vyvanse, “but our feeling is it is one more tool in the toolbox that may work for some people with BED.”
Weight Loss versus Binging
Turner says that BEDA is “very concerned about the possible off-label use of Vyvanse to treat “obesity.” The studies are clear that any weight loss associated with use of Vyvanse is transient at best. Physicians need to screen properly for BED and refer their patients to an eating disorder specialist. Off-label use of this product for weight loss is unethical and irresponsible, at best.”
Other experts in the field are also critical about using Vyvanse to treat binging behaviors. In a recent statement in the Journal Sentinel, Allen Frances, former chairman of the psychiatry department at Duke University, criticized binge-eating as a diagnosis, calling it “a makeshift diagnosis with very little research support that will now undoubtedly become a fad pushed by massive pharma advertising.”
Frances is also highly critical of Vyvanse as a treatment. “It is no different from the diet pills that don’t work for obesity, that do create a secondary illegal market, and that reap vast profits at patient expense,” Frances says. He calls the studies “small, very inadequate, short-term treatment trials,” and says the FDA “should, in my opinion, require a year of follow.”
Frances comments garnered reaction from BEDA. Turner expressed concern about Frances’ relentless assault of Binge-Eating Disorder, which she calls “unconscionable.” “We have no problem with his questioning of Vyvanse for BED, but to question the diagnosis itself indicates that he has no clue about a major portion of people who struggle with mental illness: those all along the spectrum of eating disorders,” Turner says. “This is highly concerning considering his expertise in the field of psychiatry. He has repeatedly said that BED is “pathologized gluttony” which indicates a level of ignorance and arrogance. This type of assault on our community is dangerous as it dissuades individuals who are suffering to seek help and furthers the myth that BED is about willpower.”
Treating Binge-Eating Disorder
The use of Vyvanse to treat binge eating will need further study from clinicians, and as both Allen and Turner caution, Vyvanse should not be used as a standalone approach. For some, a decrease in physical hunger may help them to temporarily abstain from binging provide a needed respite. Because binging can actually be triggered by restrictive eating, and the use of Vyvanse to curb hunger does not take into account the need for people with the disorder to learn to respond appropriately to hunger and fullness cues. It also does not resolve the need to respond to the emotional factors that can trigger binging.
People struggling with Binge eating disorder should evaluate the risks and benefits of Vyvanse with their physicians. “No drug will ever be the magic bullet for BED and even with this new “tool”, treatment with an eating disorder specialized team is required. The true work of recovery must be done with therapy and complimentary treatments as part of a team just like any mental illness,” Turner cautions.