SSRIs for Binge Eating Disorder?
July 1, 2000
SSRIs for Binge Eating Disorder?
Abstract & commentary
Source: McElroy SL, et al. Placebo-controlled trial of sertraline in the treatment of binge eating disorder. Am J Psychiatry 2000;157:1004-1006.
Binge eating disorder is generally considered less severe than bulimia, but causes significant disruption in patients lives. Efficacy studies to date for binge eating disorder have been limited. Because selective serotonin reuptake inhibitors (SSRIs) are effective in the treatment of bulimia nervosa, a related condition, trials of SSRIs for binge eating appear warranted.
The current study included outpatients between 18 and 60 years of age with binge eating disorder, characterized by at least three bingeing episodes weekly, with an episode defined as at least 1500 kcal. Patients with anorexia, psychosis, bipolar disorder, risk of suicide, or previous use of sertraline (Zoloft) were excluded. All participants were free of psychotropic medication for at least two weeks prior to randomization. After a week of single-blind placebo administration, subjects were randomly assigned to six weeks of double-blind treatment, starting with one capsule/day of either sertraline 50 mg or placebo. Subjects took one capsule for three days and thereafter the dosage could be increased between 1-4 capsules/day. At each weekly visit, the following information was obtained: number of binges (using self-report diaries); Clinical Global Improvement Impression (CGI) severity and improvement ratings; medication dose; and weight. The 24-item Hamilton Depression Rating Scale (HDRS) was administered at baseline and weeks 2, 4, and 6. Responses were characterized as remission (cessation of binges), marked decrease (75-99%), moderate decrease (50-74%), and none (less than 50%). Data were assessed using a repeated measures regression analysis and intent-to-treat analysis.
Subjects received sertraline (18) or placebo (16), with no differences between the groups at baseline in terms of age (43 vs 41), sex (89% vs 100% female), body mass index (BMI), number of binges/week (7.6 vs 7.2), HDRS score, lifetime depressive disorder (61% vs 44%), or current depression. Eight subjects withdrew before eight weeks; three from failure to come to follow-up appointments; two from refusing to stop disallowed medication; one from refusal to have a medical condition evaluated; one for a death in the family; and one because the study regimen was too intensive. No one withdrew for adverse events, which were not significantly different between the two groups. Frequency of binges, CGI scores, and BMI were significantly reduced in the sertraline group compared to placebo; HDRS scores did not significantly change. Responses in bingeing between the sertraline and placebo groups were remission (7 vs 2), marked decrease (2 vs 3), moderate decrease (3 vs 4) and none (0 vs 4). Responders taking sertraline had a higher level (i.e., intensity) of response than placebo responders, but this difference did not reach significance. The mean dose for sertraline was 184 mg/d. Limitations included a small sample size and short duration of treatment.
Comment by Donald M. Hilty, MD
Binge eating disorder causes significant impairment in function for many patients. The results of this study are encouraging since no established treatments have been previously found. SSRIs appear indicated for this disorder because of the role of serotonin in this and other disorders, particularly with comorbid anxiety, depressive, and/or bulimic disorders. The high dose is consistent with other difficult-to-treat disorders (e.g., obsessive-compulsive disorder). The high response rate to placebo indicates that psychoeducation and psychosocial treatments (e.g., cognitive behavior therapy, group therapy) have an important role as well. In a previous study, fluvoxamine (Luvox) was superior to placebo in the treatment of binge eating disorder.
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