Functional Connectivity Mechanisms Underlying Symptom Reduction Following Lisdexamfetamine Treatment in Binge-Eating Disorder: A Clinical Trial

Mapping Treatment Advances in the Neurobiology of Binge Eating Disorder: A Concept Paper

“…The functional connectivity in a range of networks believed to underlie BED was examined pre-post LDX treatment. Over 97% of the participants experienced a remission or reduction in BED symptoms after LDX pharmacological treatment; however, the fMRI data revealed an unexpected pattern of change, i.e., that there was a limited overlap between the connectivity of nodes associated with improvement following LDX and those in which the BED group differed from the control group [31]. This research highlighted that the LDX pharmacological treatment appears not to act via neural networks associated with pretreatment diagnostic features; rather, connectivity with the interoceptive network, which allows individuals to identify an awareness of their internal physiological and emotional state, is implicated in the core symptom of a loss of control seen in BED and is a target of treatment [31].…”

“…Pharmacological interventions, specifically neurostimulant LDX, have firmly emerged as a potential additional form of treatment to augment cognitive therapy for the treatment of BED. It is important that research continues to explore how LDX can be utilised in the treatment of BED, due to evidence that clearly highlights how this medication rapidly reduces binge episode frequency, impulsive eating behaviour and obsessive thinking related to food in individuals with BED [31]. Formal randomised control trial studies are required to establish the precise contribution LDX could make to the improved treatment outcomes of people with BED.…”

“…LDX is currently the only medication approved for the treatment of moderate to severe BED; however, explanations regarding its specific neurological mechanism are complex. For example, a recent study by Griffith and colleagues [31] investigated the neural mechanism of symptom improvement via LDX in individuals with moderate to severe BED who underwent baseline and 8-week follow-up functional magnetic resonance imaging (fMRI). The functional connectivity in a range of networks believed to underlie BED was examined pre-post LDX treatment.…”

“…For example, the structural and functional differences documented in reward processing, such as heightened sensitivity to highly palatable foods, greater model-free learning and heightened likelihood of engaging in repetitive, habitual behaviours when eating, could be used to educate individuals about this mental illness at a bare minimum, which would reduce stigma and shame about the aetiology of this illness. Further to this, the formal neurobiological assessment of these known differences could serve to inform an individualised treatment approach, particularly when considering an individual's case formulation and environmental vulnerabilities to binge episodes [18,19,31].…”