Safety of pharmacotherapy options for bulimia nervosa and binge eating disorder

Bello, Nicholas T.; Yeomans, Bryn L.

doi:10.1080/14740338.2018.1395854

Cited by 53 publications

(21 citation statements)

References 44 publications

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“…Presence of a comorbid anxiety disorder may weight AD choice towards a drug that is effective for those symptoms, such as OCD benefiting from an SSRI or clomipramine . Comorbid bulimia nervosa may benefit from SSRIs and anorexia nervosa by use of an AD that promotes weight gain. Substance use disorders occurring in the context of depression may affect AD choice; for example, if smoking cessation is a goal, bupropion should be considered, owing to its effects on reducing nicotine craving .…”

Section: Resultsmentioning

confidence: 99%

How to choose an antidepressant medication

Bayes

Parker

2019

Acta Psychiatr Scand

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Bayes A, Parker G. How to choose an antidepressant medication.Objective: We consider how to choose an antidepressant (AD) medication for the treatment of clinical depression. Method: A narrative review was undertaken addressing antidepressant 'choice' considering a range of parameters either weighted by patients and clinicians or suggested in the scientific literature. Findings were synthesised and incorporated with clinical experience into a model to assist AD choice. Results: Efficacy studies comparing ADs offer indicative guidance, while precision psychiatry prediction based on genetics, developmental trauma, neuroimaging, behavioural and cognitive biomarkers, currently has limited clinical utility. Our model offers guidance for AD choice by assessing first for the presence of a depressive subtype or symptom cluster and matching choice of AD class accordingly. Failing this, an AD can be chosen based on depression severity. Within-class choice can be determined by reference to personality style, patient preference, medical or psychiatric comorbidities and side-effect profile. Conclusion: Clarification of AD choice would occur if medications are trialled in specific depressive subtypes rather than using the generic diagnosis of major depressive disorder (MDD). Such 'top-down' methods could be enhanced by 'bottom-up' studies to classify individuals according to symptom clusters and biomarkers with AD efficacy tested in these categories. Both methods could be utilised for personalised AD choice.• Our model offers guidance of AD choice by assessing for a depressive subtype (e.g. melancholic), symptom cluster or weighting by severity and matching choice of AD class accordingly.• Within-class AD choice can be determined by reference to factors such as personality style, patient preference, medical or psychiatric comorbidities.• Clarification of AD choice would occur if medications are trialled in those with specific depressive subtypes rather than in relation to MDD, with complementary 'bottom-up' studies classifying individuals according to symptom clusters and biomarkers with AD efficacy tested in these categories. Additional Comments• The dominant use of the major depressive disorder (MDD) diagnosis homogenises a variable set of depressive conditions which obscures the ability to detect treatment effects and inform antidepressant choice.• Extrapolating AD trial efficacy data to 'real-world' clinical practice is limited by trials excluding those with more severe depressive disorders.• There is a lack of agreement in validly defining depressive 'subtypes', as well as the relationship between surface symptoms and underlying endophenotypes.

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Section: Resultsmentioning

confidence: 99%

How to choose an antidepressant medication

Bayes

Parker

2019

Acta Psychiatr Scand

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“…SSRIs have demonstrated to be useful treatment options for bulimia nervosa (BN) and binge eating disorder (BED) [30]. Fluoxetine is the only SSRI with FDA approval for BN, though other SSRIs have shown effectiveness [30][31][32]. In BED, a meta-analysis of 45 studies showed SSRIs provided some improvement in remission and reduction in the frequency of binge eating but no improvement in patient BMI [33].…”

Section: Eating Disordersmentioning

confidence: 99%

Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review

Edinoff

Akuly

Hanna

et al. 2021

Neurology International

155

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Depression is the most prevalent psychiatric disorder in the world, affecting 4.4% of the global population. Despite an array of treatment modalities, depressive disorders remain difficult to manage due to many factors. Beginning with the introduction of fluoxetine to the United States in 1988, selective serotonin reuptake inhibitors (SSRIs) quickly became a mainstay of treatment for a variety of psychiatric disorders. The primary mechanism of action of SSRIs is to inhibit presynaptic reuptake of serotonin at the serotonin transporter, subsequently increasing serotonin at the postsynaptic membrane in the serotonergic synapse. The six major SSRIs that are marketed in the USA today, fluoxetine, citalopram, escitalopram, paroxetine, sertraline, and fluvoxamine, are a group of structurally unrelated molecules that share a similar mechanism of action. While their primary mechanism of action is similar, each SSRI has unique pharmacokinetics, pharmacodynamics, and side effect profile. One of the more controversial adverse effects of SSRIs is the black box warning for increased risk of suicidality in children and young adults aged 18–24. There is a lack of understanding of the complexities and interactions between SSRIs in the developing brain of a young person with depression. Adults, who do not have certain risk factors, which could be confounding factors, do not seem to carry this increased risk of suicidality. Ultimately, when prescribing SSRIs to any patient, a risk–benefit analysis must factor in the potential treatment effects, adverse effects, and dangers of the illness to be treated. The aim of this review is to educate clinicians on potential adverse effects of SSRIs.

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“…Given the potential risks of stimulants in BN, an RCT would ideally examine whether a stimulant has advantages over other available medications with proven safety profiles. For example, fluoxetine (60 mg/day dosage) has regulatory approval as a treatment for BN based on efficacy and a very good safety profile in both short‐ and long‐term trials (Bello & Yeomans, 2018). Therefore, it would be sensible to compare a stimulant to fluoxetine (60 mg/day dosage), to assess whether a stimulant is more efficacious than fluoxetine.…”

Section: Future Directions For Researchmentioning

confidence: 99%

The potential role of stimulants in treating eating disorders

Keshen

Bartel

Frank

et al. 2021

Intl J Eating Disorders

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Background Many individuals with eating disorders remain symptomatic after a course of psychotherapy and pharmacotherapy; therefore, the development of innovative treatments is essential. Method To learn more about the current evidence for treating eating disorders with stimulants, we searched for original articles and reviews published up to April 29, 2021 in PubMed and MEDLINE using the following search terms: eating disorders, anorexia, bulimia, binge eating, stimulants, amphetamine, lisdexamfetamine, methylphenidate, and phentermine. Results We propose that stimulant medications represent a novel avenue for future research based on the following: (a) the relationship between eating disorders and attention deficit/hyperactivity disorder (ADHD); (b) a neurobiological rationale; and (c) the current (but limited) evidence for stimulants as treatments for some eating disorders. Despite the possible benefits of such medications, there are also risks to consider such as medication misuse, adverse cardiovascular events, and reduction of appetite and pathological weight loss. With those risks in mind, we propose several directions for future research including: (a) randomized controlled trials to study stimulant treatment in those with bulimia nervosa (with guidance on strategies to mitigate risk); (b) examining stimulant treatment in conjunction with psychotherapy; (c) investigating the impact of stimulants on “loss of control” eating in youth with ADHD; and (d) exploring relevant neurobiological mechanisms. We also propose specific directions for exploring mediators and moderators in future clinical trials. Discussion Although this line of investigation may be viewed as controversial by some in the field, we believe that the topic warrants careful consideration for future research.

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Safety of pharmacotherapy options for bulimia nervosa and binge eating disorder

Cited by 53 publications

References 44 publications

How to choose an antidepressant medication

How to choose an antidepressant medication

Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review

The potential role of stimulants in treating eating disorders

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