As of February 2015, the FDA approved the psychostimulant Vyvanse (Lisdexamfetamine) for the treatment of binge eating disorder. In recent years, the popularity of Vyvanse has skyrocketed as an ADHD medication, as well as among those seeking to use it for ulterior purposes such as weight loss, academics, and sports performance. Many consider the medication to be equal in efficacy (and in some cases more effective) than Adderall for treating attentional deficits.
Although this drug is a Schedule II controlled-substance (due to potential for abuse), many doctors believe that it has some benefits over older medications. One such benefit is that it is a “prodrug” which means it is inactive until it is ingested and metabolized within the body. This tends to result in a smoother absorption and a longer-lasting effect (up to 12 hours in some people).
Recently Vyvanse met all endpoints in Phase III clinical trials for the treatment of “binge eating disorder,” a condition that is thought to plague between 1% and 5% of the U.S. population. An estimated 2.8 million people suffer from this condition that can lead to obesity, mental illness, and a pose variety of other serious health risks. Vyvanse was found significantly more effective than a placebo at reducing the number of binge eating episodes in those with the disorder.
Vyvanse for Binge Eating Disorder: Clinical Research
What is binge eating disorder? Binge eating disorder (BED) is a condition characterized by recurrent episodes of binge eating or eating in excess. The condition also involves feelings of distress about being unable to control the urge to binge. For an official diagnosis, you must have episodes of binge eating spanning over a period of 90 days. The condition was formally recognized and incorporated in the DSM-V in 2013.
The pharmaceutical heavyweight Shire had an inkling that their medication Vyvanse may be effective in controlling this disorder. After all, it does tend to reduce appetite, and is associated with weight loss. Those taking the drug have more control over impulses, therefore it was logical to think that it would help those suffering from binge eating disorders.
Study: Participants between ages 18 and 55 were randomly assigned a fixed-dose of Vyvanse or a placebo (at a 1:1 ratio). Those that received the fixed doses of Vyvanse were given either 30 mg, 50 mg, or 70 mg per day. All of the studies were considered randomized, double-blind, and placebo-controlled. They were designed to determine the safety, efficacy, and tolerability of Vyvanse among individuals meeting criteria for Binge Eating Disorder (as defined by the DSM-IV). The patients were then screened at various intervals throughout 12 weeks of treatment to determine whether the drug had reduced the number of binge eating days and episodes.
Participants: In clinical research, 724 participants were involved to help determine whether Vyvanse was effective for the treatment of binge eating disorder. Most participants involved in the research were in their late 30s and had BMIs (body mass indexes) ranging between 25 and 45. It should be noted that although there were both males and females involved in the research, a majority were female.
Results: The results in both identically designed studies demonstrated that the patients receiving the Vyvanse 50 mg and 70 mg experienced a statistically significant reduction in the number of binge eating days (and episodes) in comparison to a placebo. Approximately 50% of those taking 70 mg of Vyvanse stopped binge eating for the 4-week study compared to 21% of those taking the placebo.
Most of the people taking the drug also ended up losing weight. Secondary endpoints and evaluations such as: changes in body weight (from baseline), CGI-I scores, Y-BOCS-BE scores, and 4-week cessation of binge eating scores were also taken into consideration. Participants demonstrated significant improvement on all of the secondary evaluations.
To verify the accuracy of the results, patients were interviewed by clinicians. For further information on the studies, look up “SPD489-343” which involved 383 patients, and “SPD489-344” which involved 390 patients.
- Source: https://clinicaltrials.gov/ct2/show/NCT01718483
- Source: https://clinicaltrials.gov/ct2/show/NCT01718509
Did dosage of the Vyvanse matter?
Yes. According to researchers, patients that took a placebo drug had a total of ~2 binge days throughout the study, whereas those receiving 50 mg or 70 mg of Vyvanse experienced an average of 0.3 (50 mg) and 0.1 (70 mg) binge days. It should be noted that the 30 mg dosage wasn’t found to be statistically significant from a placebo. This suggests that when people start taking the drug to treat binge eating disorder, they’re likely to start at a moderate (or high) dose.
Baseline measures revealed that prior to taking either Vyvanse or a placebo, patients had an average of 4.79 binge days per week. The fact that moderate to high doses of Vyvanse reduced the number to less than 1 day per week is highly significant. That said, it also demonstrates the sheer potency of high dose Vyvanse.
How Vyvanse Treats Binge Eating Disorder
There are several ways by which Vyvanse is thought to help treat binge eating disorder. The drug is inherently an appetite suppressant, which means while taking it, you’re unlikely to even think about food – especially at high doses. It also increases dopamine which enhances a person’s capacity of self-control even when faced with an urge to binge.
- Appetite suppression: Vyvanse is known to reduce appetite, especially at doses of 50 mg or 70 mg. When taking it, you may forget to eat or in some cases have to force yourself to eat. This is mostly related to the fact that the drug stimulates a release of dopamine and the sympathetic nervous system.
- Boosts cognition: Increasing cognitive function has carryover in nearly all aspects of life, including unwanted behaviors. By boosting your cognitive capacity, you will get a better understanding of what it’s like to avoid binging and come up with a strategy to prevent yourself from future episodes of binge eating.
- Controls compulsions: For those that compulsively binge on food, the Vyvanse will help make correcting this behavior easier. Not only will it make you feel less hungry, but should you ever get caught up in an episode, it will help you attain the awareness to take a step-back and help you realize that there are other options.
- Dopamine increase: When dopamine levels increase, we feel less of a need to eat and are less likely to think about food. By artificially elevating dopamine levels with Vyvanse, you aren’t going to be as inclined to seek out the dopamine boost that comes with binging on certain foods because your dopamine is already boosted. Many people with low dopamine are thought to have problems with binge eating and obesity due to the fact that they never achieve satisfactory dopamine levels to feel satiated.
- Lessens cravings: Some people crave certain foods that they can binge on. Having constant cravings for certain foods makes it extremely difficult to resist the urge to overeat. Taking Vyvanse reduces a person’s cravings for food due to the fact that their dopamine levels are now higher and they have greater cortical activation.
- Reduces impulsivity: In addition to increasing dopamine, it is believed that the drug also improves functioning within the prefrontal cortex of the brain. Lack of activity in the prefrontal cortex is associated with impulsive behavior and being unable to control animalistic urges of the reptilian area of the brain. Therefore you are less susceptible to impulsive purging.
- Self-control: Those with binge eating disorder often lack proper self-control to resist urges to eat in excess. Taking Vyvanse increases levels of dopamine, activity in the prefrontal cortex, and ultimately your self-control. This means that you will feel more in charge of your circumstances rather than being controlled by urges to binge.
Should Vyvanse be used for binge eating disorder?
It’s up for debate as to whether this drug should be approved to treat binge eating disorder. However, for someone who is on the verge of dying a slow death as a result of binge eating-induced obesity – it’s probably one of the better options. Determining whether Vyvanse should be used should be determined based on the individual, not as a result of FDA approval.
For some individuals, the drug may end up being a life-saver, while for others it may lead to nothing but abuse, addiction, and long-term problems. It is important to realize that this drug is considered relatively safe, and when compared to other pharmaceutical options for the treatment of binge eating disorder (e.g. SSRIs, Topamax, etc.), some would argue that Vyvanse is a significant improvement.
Risks of Vyvanse for Binge Eating Disorder
There are several risks that should be associated with Vyvanse. It is a “Schedule II” drug in the U.S. for a reason – it has a high potential for abuse. When abused, the drug may lead to a significant degree of psychological dependence.
- Abuse: Many people take this drug with no initial intention of abusing it, but still end up doing so. Some people experience a degree of euphoria, increased pleasure, and/or improved performance, that they cannot resist taking more than they’re prescribed. This results in building a tolerance to a higher than average dose, and often results in detrimental psychological effects.
- Addiction: Some people become addicted to stimulant drugs for a variety of reasons. You may notice that Vyvanse causes weight loss and like how the drug makes you look. You may also be happy with the fact that you’re no longer binge eating and/or have improved in ability to perform at work (or school). Seeking out the drug for purposes other than treating your condition is a sign of addiction.
- Dependence: At some point you may become dependent on this drug for daily functioning. Those that take it for a long-term at a high dose may experience difficulty when trying to function without it. If you feel as if you “need” the drug in order to socialize, do your work, or get things done, or feel as if your ability to perform is at the mercy of the drug, you are likely dependent.
- Long-term effects: While most research reveals that amphetamines tend to be relatively safe over the long-term, it is unknown how taking the drug for an extended period could affect you on an individual basis. Everyone has different genetics and ultimately staying on a drug for years at a time could trigger another health condition (e.g. heart problems).
- Rebound binge eating: If you need to withdraw from the medication, it may result in rebound episodes of binge eating. These episodes may be more severe than those that you experienced prior to taking the drug. In other words, you may have only had 3 episodes per week before the drug, 0 per week while on the drug, but during a rebound you may have 6 per week. Although rebound episodes aren’t common for everyone, they can occur.
- Side effects: This is a stimulant drug which means it increases activity in the central nervous system. This can create unwanted side effects in some people such as: high anxiety, heart palpitations, jitters, and insomnia. More serious adverse effects could include: a heart attack, stroke, mania, and/or psychosis. If you have any heart conditions and/or defects, this drug could exacerbate them.
- Tolerance: Once a person develops tolerance to high doses of Vyvanse, this may result in reduced efficacy for the treatment of binge eating. Becoming tolerant may require increasing the dose to abnormally high quantities, potentially leading to more severe side effects. Tolerance generally results in less benefit for treating the intended condition.
- Withdrawal: Should you ever need to go through Vyvanse withdrawal, the discontinuation process can be very difficult. You may experience mood swings, heightened anxiety, and a sense of dysphoria as a result of low dopamine levels. It takes time for the brain to reestablish homeostatic dopamine function upon discontinuation.
Why most stimulants likely work for binge eating disorders…
Although Vyvanse seems to be the first amphetamine-based stimulant approved for the treatment of binge eating disorder, most psychostimulants likely elicit similar effects. The usage of drugs like Adderall have been known for years to be helpful for certain individuals in managing their binge eating disorder as well as obesity. Most amphetamines and stimulatory drugs increase the neurotransmitter dopamine, eliciting very similar effects.
Whether a drug gets “approval” by the FDA largely comes down to study design, the drug’s mechanism of action, and sometimes a bit of luck. My guess is that most amphetamine-based stimulants would work well for the treatment of binge eating with similar study designs.
Optimal usage: ADHD with comorbid Binge Eating Disorder
The bottom line is that now Vyvanse has been promoted as being clinically effective for binge eating disorder, the ideal candidate for the drug would be someone who also has ADHD. People with attention deficit hyperactivity disorder and comorbid binge eating episodes may find that the drug metaphorically “kills 2 birds with one stone.” Keep in mind that not everyone is going to have ideal responses to this drug in terms of side effects, but for most people it will treat both conditions.
Those with only binge eating disorder and no ADHD may want to explore other options before pursuing Vyvanse as there is always potential for abuse and addiction. Before trying any medication, it is always recommended to first try CBT (cognitive-behavioral therapy). If CBT doesn’t seem to be enough help, then adding a pharmaceutical like Vyvanse will likely offer additional benefit.