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What medications have you found that have worked for binge eating disorder or bulimia? Topamax kinda helps, but I hate the side effects (depression, hair loss, slowed thinking, tiredness, etc....) and was wondering if anybody else had success with any other medications. Or if you've found ways to deal with the cognitive side effects of topamax?

Thank you. 

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Have you tried naltrexone?  That med has saved me.  You still get hungry as usual, but when you eat, you don't get the craving feeling for more and more food.

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Yes!!! I recently started taking it and noticed that it helped a LOT, but my issue with naltrexone is that it makes me SOOOO sleepy. It is awesome, don't get me wrong, but I just feel like sleeping 24/7. Do you have this issue? Or if you do, what do you do to deal with it? Because I really want to stay on naltrexone, I just need ways of coping with the sleepiness. I've found that topamax and naltrexone together are the best combo so far, I'm just so sleepy! (I take the topamax at night). 

 

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5 hours ago, ktfergie said:

Yes!!! I recently started taking it and noticed that it helped a LOT, but my issue with naltrexone is that it makes me SOOOO sleepy. It is awesome, don't get me wrong, but I just feel like sleeping 24/7. Do you have this issue? Or if you do, what do you do to deal with it? Because I really want to stay on naltrexone, I just need ways of coping with the sleepiness. I've found that topamax and naltrexone together are the best combo so far, I'm just so sleepy! (I take the topamax at night). 

 

No, it doesn't make me sleepy.  What dose are you on?  If just once/day, could you take it at night? 

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I just started ( yesterday) taking it only at night. I was afraid that it wouldn't last through the day if I only took it at night (the naltrexone). I take 100mg. 

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4 hours ago, ktfergie said:

I just started ( yesterday) taking it only at night. I was afraid that it wouldn't last through the day if I only took it at night (the naltrexone). I take 100mg. 

Is the 100 mg divided into 2-50 mg tablets?  I find that spreading them out covers me for the enitre day, as opposed to taking then at once.  I am on 3, 50mg tablets 3x/day (=150 mg).

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Vyvanse has an indication for BED, and could augment the Topamax and naltrexone quite nicely and even help you lose some weight with the combo of Topamax and Vyvanse. It would be similar to the combination of bupropion and naltrexone (Contrave), since Vyvanse (prodrug for dextroamphetamine) releases and is a reuptake inhibitor of norepinephrine and dopamine. It's also similar to the combination of phentermine and topiramate (Qsymia).

According to Stephen M. Stahl in Stahl's Essential Psychopharmacology...

Quote

<Phentermine> (Vyvanse) increases dopamine (DA) and norepinephrine (NE) in the hypothalamus by blocking both the norepinephrine and dopamine reuptake transporters (NET and DAT, respectively) (it actually causes their release, too, like Vyvanse). The increased input of DA and NE onto pro-opiomelanocortin (POMC) neurons in the appetite-suppressing pathway partially activates the POMC neurons, causing an increase in α-melanocyte-stimulating hormone (α-MSH) release, which binds to melanocortin 4 receptors (MC4R) to suppress appetite partially.

(Meanwhile, the appetite-stimulating pathway is still releasing neuropeptides like agouti-related peptide (AgRP) and neuropeptide-Y (NPY), which increase appetite.)

Topiramate hypothetically inhibits the appetite-stimulating pathway [...] by reducing excitatory glutamatergic input and by increasing inhibitory GABA-ergic input. Combining this with <phentermine's> (Vyvanse's) actions [...] that stimulate the appetite-suppressing pathway, this results in a synergistic and enhanced effect on appetite and on weight loss, allowing lower, more tolerable doses of both <phentermine> (Vyvanse) and topiramate to be used.

(Topiramate and zonisamide both inhibit the appetite-stimulating pathway, inhibiting the release of neuropeptides agouti-related peptide (AgRP) and neuropeptide-Y (NPY), decreasing appetite stimulation.)

The antidepressant and smoking cessation aid bupropion (which can be substituted with Vyvanse) is thought to have effects in the appetite center of the hypothalamus [...]. <Bupropion> (Vyvanse) increases dopamine (DA) and norepinephrine (NE) in the hypothalamus by blocking both the norepinephrine and dopamine transporters (NET and DAT, repsectively) (and Vyvanse causes release of DA and NE additionally) [...]. The increased input of DA and NE onto pro-opiomelanocortin (POMC) neurons in the appetite-suppressing pathway partially activates the POMC neurons causing an increase in α-melanocyte-stimulating hormone (α-MSH), which binds to melanocortin 4 receptors (MC4R) to suppress appetite partially. The actions of <bupropion> (Vyvanse) on the appetite-suppressing pathway, however, are mitigated because stimulation of POMC neurons also activates an endorphin/endogenous-opioid-mediated negative feedback loop (also with <phentermine> (Vyvanse)).

Both naltrexone and <bupropion> (Vyvanse) alone can lead to some weight loss by themselves. However, the combination of naltrexone and <bupropion> (Vyvanse) has a synergistic effect on weight loss that surpasses monotherapy with either agent by dual pharmacologic actions on the appetite-suppressing pathway. That is, naltrexone blocks the endogenous-opioid-mediated negative feedback loop that normally limits the activation of pro-opiomelanocortin (POMC) neurons in the appetite-suppressing pathway. With this negative feedback removed by administration of naltrexone, <bupropion> (Vyvanse) can more readily increase firing of POMC neurons, leading to highly elevated levels of α-melanocyte-stimulating hormone (α-MSH), which binds more robustly to melanocortin 4 receptors (MC4R) to more potently suppress appetite and cause more weight loss.

 
 

So Vyvanse, topiramate, and naltrexone would be an extremely synergistic combination. Plus the Vyvanse would counteract the sedation from the other meds.

If you end up not being able to tolerate topiramate, give zonisamide (Zonegran) a try. It has very similar actions, possibly more robust than topiramate, and you might be able to tolerate it better.

Edited by mikrw33
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I'm a normal/healthy weight so losing weight or gaining weight or numbers on a scale isn't my main priority. It's mainly about how I feel and how much my eating disorder is affecting my life. For example, about 9 years ago, I would binge and purge up to 10 times per day. Currently my only problem is that only sometimes (maybe a few meals a week) I overeat a little bit. Not like a full on binge, and not so much that my stomach feels like it's going to burst, but just enough that I'm unhappy with myself and I don't feel in control. It's not like what my old binges used to be, but it's more than what I eat in a normal meal. I don't know if I'm explaining this thoroughly, or if I just sound like a crazy eating disordered whack job, but eh.... 

I'm not fond of topamax or zonegran because of the side effects: not being able to focus or learn, feeling/sounding stupid, not being able to sweat and overheating (& I live in FL), hair loss, acne, the random outburst in tears, etc.... I'm actually considering taking topamax out of the equation just because it does have so many terrible side effects for what little benefit it provides. I actually think that the naltrexone has provided the biggest benefit for me. I'm not sure why....  

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4 hours ago, ktfergie said:

I'm a normal/healthy weight so losing weight or gaining weight or numbers on a scale isn't my main priority. It's mainly about how I feel and how much my eating disorder is affecting my life. For example, about 9 years ago, I would binge and purge up to 10 times per day. Currently my only problem is that only sometimes (maybe a few meals a week) I overeat a little bit. Not like a full on binge, and not so much that my stomach feels like it's going to burst, but just enough that I'm unhappy with myself and I don't feel in control. It's not like what my old binges used to be, but it's more than what I eat in a normal meal. I don't know if I'm explaining this thoroughly, or if I just sound like a crazy eating disordered whack job, but eh.... 

I'm not fond of topamax or zonegran because of the side effects: not being able to focus or learn, feeling/sounding stupid, not being able to sweat and overheating (& I live in FL), hair loss, acne, the random outburst in tears, etc.... I'm actually considering taking topamax out of the equation just because it does have so many terrible side effects for what little benefit it provides. I actually think that the naltrexone has provided the biggest benefit for me. I'm not sure why....  

I understand what you are saying.

Naltrexone has definitely provided a huge benefit for me ... it keeps me from overeating and then regretting it.  I don't have an ED anymore and my mindset has changed.  However I think that without the naltrexone, my mindset could change again (in a bad way) if I were start to start bingeing and starving again.  And then the out-of-control feelings start etc.  So naltrexone is a life saver for me too.

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On 9/18/2016 at 0:05 PM, mikrw33 said:

Vyvanse has an indication for BED, and could augment the Topamax and naltrexone quite nicely and even help you lose some weight with the combo of Topamax and Vyvanse. It would be similar to the combination of bupropion and naltrexone (Contrave), since Vyvanse (prodrug for dextroamphetamine) releases and is a reuptake inhibitor of norepinephrine and dopamine. It's also similar to the combination of phentermine and topiramate (Qsymia).

According to Stephen M. Stahl in Stahl's Essential Psychopharmacology...

So Vyvanse, topiramate, and naltrexone would be an extremely synergistic combination. Plus the Vyvanse would counteract the sedation from the other meds.

If you end up not being able to tolerate topiramate, give zonisamide (Zonegran) a try. It has very similar actions, possibly more robust than topiramate, and you might be able to tolerate it better.

Very few doc's will prescribe Vyvanse as it's an amphetamine and a powerful one at that.HIgh abuse potential, psychosis inducing etc

I would personally love to be on vyvanse and take it responsibly since my fatigue/anhedonia has lasted 8 months now.

but if you have a doc who's willing, it's worth a try IMO.

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