Australian clinical guidelines for the treatment of ED recommend that pharmacotherapy be considered when psychotherapy is not available, or as an adjunctive treatment to psychotherapy [870]. Although there are no current evidence-based pharmacotherapies for treating co-occurring binge-eating disorder and AOD use, there is emerging evidence suggesting that pharmacotherapy may be beneficial for some people with binge eating disorder as a single disorder [1461, 1465]. RCTs examining the efficacy of SSRIs (fluoxetine, citalopram, escitalopram, fluvoxamine, and sertraline [1464]), SNRIs (duloxetine [1466]), mood stabilisers (topiramate [1467]), anticonvulsants (lamotrigine [1468]), antiobesity medications (orlistat [1464]), and psychostimulants (lisdexamfetamine [1464]), have found reductions in the frequency of binge eating episodes, BMI decreases, and overall clinical improvement.
Five RCTs to date have evaluated lisdexamfetamine for single disorder binge eating disorder, with findings demonstrating strong evidence in support of its safety and efficacy [1469–1473]. These studies found that compared to placebo, lisdexamfetamine was associated with significant improvements in binge-eating symptoms, reduced frequency of binge-eating episodes, and reduced body weight [1474]. The anticonvulsants topiramate and lamotrigine have also been evaluated for efficacy and safety for single disorder binge eating disorder in several RCTs [1467, 1468, 1475, 1476]. Although topiramate has been associated with adverse side effects (e.g., participants dropping out of trials with headache, paresthesias or pins and needles sensations), these studies found that, compared to placebo, topiramate was associated with significantly greater reductions in binge frequency, BMI, and weight loss. The antiobesity medication Orlistat has been examined for efficacy in four RCTs to date [1463, 1477–1479]. These trials found that, although weight loss was enhanced with Orlistat, the frequency of binge eating was not reduced.
There is also some evidence to support the use of pharmacotherapies which target AOD use, such as baclofen, acamprosate, and bupropion, for the treatment of binge-eating disorder as a single disorder [1480, 1481]. Two narrative reviews concluded that, while baclofen reduces the frequency of binge-eating episodes [1480, 1481], depressive symptoms may increase [1481] relative to baseline. In these reviews, bupropion also reduced the frequency of binge-eating episodes relative to baseline, and improved weight goals relative to both a placebo and sertraline, although the findings for binge-eating episodes were somewhat mixed [1480, 1481]. In one RCT, acamprosate also reduced the frequency of binge-eating episodes, as well as related factors such as food cravings and compulsive eating, relative to before treatment, but not relative to placebo [1482].