Binge Eating Disorder Medications

[mikl_pls]

I am going to speak to my pdoc about this, but I think I have binge eating disorder. I have gained an unspeakable amount of weight just in the past month, and am about to break my all time high in weight. These binges seem to come in "spells" or "episodes" that last for several months unless I'm dieting, and it's incredibly frustrating. Last year, I lost 40 lb and nearly got to my target weight, and I suddenly started binge eating when I had a change in medication. Right now, I'm not on any medication that would induce weight gain or increase appetite all that much or at all really, that I know of.

I've been researching binge eating disorder (BED) medications, and this is what I've come up with. Please let me know if there's anything else I could add to this list. I plan on asking my pdoc about all of them and possibly adding them to my (already extensive) list of meds.

Antidepressants
I'm on Parnate, so I can't take SSRI's or SNRI's, but I'm on the TCA desipramine (Norpramin), which has been studied in binge eating disorder in dosages up to 300 mg. With the combo of my MAOI, I won't be able to go up that high, my current dose of 150 mg is probably as high as I will be able to go.

Anti-obesity medications
With my MAOI, the only one I think I can take is Orlistat, which I've heard has a lot of GI side effects (unless you eat a low fat diet, which tend not to work for me. I tend to respond better to low carb, high protein, high fat diets). In the past I've taken phentermine, which has worked fantastically, as well as diethylpropion, but because of my MAOI and Adderall, I don't think I can take those.

Antiepileptic drugs

• Topamax — Studied in doses from 50-600 mg. I've taken this before up to 200 mg and it really didn't have an effect on my appetite. I can't take it though because both times I took it, it gave me kidney stones really bad.
• Zonegran — Studied in doses from 100-600 mg. I currently take this at 300 mg, and I don't really notice it affecting my appetite. I'd like to try higher doses of it, but my pdoc simply won't raise the dose of it for some reason.
• Lamictal — Studied in doses from 50-400 mg. I'm already on 300 mg. "Because lamotrigine and placebo had similarly high rates of reduction of weekly frequency of binge-eating episodes, the efficacy of lamotrigine in BED could not be determined. However, lamotrigine was associated with a numerically greater amount of weight loss (1.17 kg for lamotrigine versus 0.15 kg for placebo) and statistically significant reductions in fasting levels of glucose, insulin, and triglycerides, consistent with the finding that lamotrigine is associated with weight loss in healthy patients with obesity."

ADHD drugs

• Strattera — Studied in doses of 40-120 mg. I'm not sure if I could take this with my MAOI, but then again, it's a selective NRI, which is pretty much what desipramine is, so perhaps I could trade out desipramine for Strattera? The ending mean dose was 106 ± 21 mg/day. I'm not sure I could go that high with Parnate.
• Vyvanse — I know this is approved for BED, but I'm already taking Adderall, which I prefer to Vyvanse.

Antiaddiction drugs

• Opioid antagonists — naltrexone — studied in doses of 200-400 mg/day — this one shows a lot of promise. I'm definitely going to ask about this one.
• Acamprosate — Mean endpoint dose was 2597 ± 605 mg/day, which is pretty high to my understanding. "Acamprosate was not associated with a significantly greater decrease in binge eating frequency or any other outcome measure in the primary longitudinal analysis. However, in the secondary endpoint analysis, acamprosate was associated with statistically significant improvement in binge day frequency and in measures of obsessive-compulsive symptoms of binge-eating, food craving, and quality of life. BMI decreased slightly with acamprosate and increased with placebo; among completers, BMI decreased significantly with acamprosate than placebo recipients.

Other agents

• Memantine (Namenda) — studied in dosages up to 20-30 mg/day, but I'm sure my insurance has a quantity limit of 20 mg/day.
• Sodium oxybate (Xyrem) — there's practically no chance of my pdoc prescribing this to me...
• Baclofen — One study used 60 mg, in which two of the subjects gained weight but had reduced binge-eating frequency, while another study used 120-180 mg.

Am I missing anything? If so, please comment.

[KnickNak]

I noticed you have taken Welly in the past and had positive results? Lots of people who have taken this drug have lost weight . Can I ask why you stopped? And also that sucks about Topamax, I am on 100mg.. I do get nauseous on it.. and my appetite has curved since being on Seroquel which helped a lot. 

Do you notice a time in the day when you are binge eating?

[mikl_pls]

1 minute ago, KnickNak said:

I noticed you have taken Welly in the past and had positive results? Lots of people who have taken this drug have lost weight . Can I ask why you stopped? And also that sucks about Topamax, I am on 100mg.. I do get nauseous on it.. and my appetite has curved since being on Seroquel which helped a lot. 

Do you notice a time in the day when you are binge eating?

 

I had to stop Wellbutrin because it was causing uncontrollable muscle tremors and possible seizures (mostly absence seizures, a few possible complex partial or grand mal seizures). It's weird because I took it for several years before it started suddenly doing that.

I seem to kind of graze all day, but I do have a particular problem with binge eating after supper/before bed as well as night eating (waking up in the middle of the night and binge eating then).

[Hopelessly Broken]

Something more important, you can't treat an ED with just meds. They are a complex psychological illness. It is far more important to find the root of it and tackle that, otherwise you will get nowhere. 

Yes, sometimes meds can be part of treating it, but it is kind of dumb to fully rely on them. 

Second, many people struggle with receiving validation that they have this illness. Binge eating is less understood than restriction is, although all EDs often receive stigma and stereotyping, poor access to treatment and so forth. Of course that will depend on your pdoc, but just thought I would mention it because I certainly wasn't aware of it when I first admitted that I have a problem with it. 

6 years later and I still have not been diagnosed officially. Dieticians have been a pain in my ass to say the least, and I still use behaviour multiple times a week. 

That has reduced though, and I am trying hard on my own. Not very effective but I have no other choice because of where I live. 

[cloudmonger]

1 hour ago, mikrw33 said:

I am going to speak to my pdoc about this, but I think I have binge eating disorder. I have gained an unspeakable amount of weight just in the past month, and am about to break my all time high in weight. These binges seem to come in "spells" or "episodes" that last for several months unless I'm dieting, and it's incredibly frustrating. Last year, I lost 40 lb and nearly got to my target weight, and I suddenly started binge eating when I had a change in medication. Right now, I'm not on any medication that would induce weight gain or increase appetite all that much or at all really, that I know of.

I've been researching binge eating disorder (BED) medications, and this is what I've come up with. Please let me know if there's anything else I could add to this list. I plan on asking my pdoc about all of them and possibly adding them to my (already extensive) list of meds.

• Lamictal — Studied in doses from 50-400 mg. I'm already on 300 mg. "Because lamotrigine and placebo had similarly high rates of reduction of weekly frequency of binge-eating episodes, the efficacy of lamotrigine in BED could not be determined. However, lamotrigine was associated with a numerically greater amount of weight loss (1.17 kg for lamotrigine versus 0.15 kg for placebo) and statistically significant reductions in fasting levels of glucose, insulin, and triglycerides, consistent with the finding that lamotrigine is associated with weight loss in healthy patients with obesity."

Am I missing anything? If so, please comment.

Sorry this is happening to you. Do you think it is stress-related? I had this problem mainly with Zyprexa & Remeron. The midnight "snacks" were becoming HUGE meals...almost in a trance, stuffing my face mindlessly and it was awful! It was like unsatiable.

I honestly don't know what to suggest considering what you have tried and the weight-neutral medications you are on. That's really interesting what you've listed about Lamictal....Since I've started Lamictal in Oct/Nov, I've lost about 8 pounds (mind you I am already skinny) this is with no change in diet or exercise. But, I see you are already on a high dose of Lamictal.

Have you tried to stock your kitchen with only super healthy-fiber filled stuff? Drink more liquids (Lamictal makes me super dehydrated, so I drink more water), Even brushing your teeth, flossing & using strong mouthwash immediately before/after meals can sometimes break the habit (your mouth feels so clean, you don't want to "taint" the super minty taste) Sometimes eating something intensely flavored (like wasabi peas spicy/salty/or super sour) helps me eat less too, or eat a tiny bit of something super crunchy with alot of texture? When I get stressed, I crave very salty/crunchy foods like popcorn or salty pretzels. Then I gulp a huge amount of water and I feel full/bloated pretty fast.

Sorry if these are silly suggestions, but trying to think of stuff that has helped me. It doesn't sounds like your issue can best be solved with medication (IMO) I would be more apt to figure out the underlying reason that is causing the behavior. And try to modify the behavior using different methods/skills that a professional (not me) would know.

Edited February 1, 2017 by cloudmonger

[melissaw72]

I take naltrexone because the voracious appetite I have was a side effect of clozaril (I was fine before that), and when I went off of it, that side effect never went away.  So my pdoc prescribed naltrexone and it has been a savior.  I had gained so. much. weight. before I started it.  I lost some of it, but not back down to my original weight.

I still get hungry and all, but it significantly lessens the constant uncontrollable wanting to eat and huge appetite.

It sucks that this is happening to you.  I'm sorry it is.  I hope you find something that can work for you.

[mikl_pls]

I've never felt so shot down by my pdoc before. She's usually so open-minded, but every single medication I mentioned she shot down, and she seemed completely dismissive about the fact that I could possibly have BED or NES. She didn't even put them on my list of diagnoses. I was really counting on her to help me with this. She offered me Adipex-P in place of Adderall, but it doesn't have the same mood-enhancing effects that Adderall has. Plus Adipex-P hasn't been proven to help with binge eating because it doesn't address the reward pathway in the mesolimbic pathway when you eat. I ugly cried the next day for at least an hour while my mom tried to console me. She wants to do anything she can to help me, but in the mind state I'm in, I don't feel like anything could help. She told me to stop taking desipramine which I thought would help with binge eating. She also lowered my Parnate dose from 30 mg to 20 mg. I've never felt so let down by my pdoc. I feel like I have no hope with my binge-eating, which I'm not even sure if I have because I didn't get an official diagnosis of.

[melissaw72]

7 hours ago, mikrw33 said:

I've never felt so shot down by my pdoc before. She's usually so open-minded, but every single medication I mentioned she shot down, and she seemed completely dismissive about the fact that I could possibly have BED or NES. She didn't even put them on my list of diagnoses. I was really counting on her to help me with this. She offered me Adipex-P in place of Adderall, but it doesn't have the same mood-enhancing effects that Adderall has. Plus Adipex-P hasn't been proven to help with binge eating because it doesn't address the reward pathway in the mesolimbic pathway when you eat. I ugly cried the next day for at least an hour while my mom tried to console me. She wants to do anything she can to help me, but in the mind state I'm in, I don't feel like anything could help. She told me to stop taking desipramine which I thought would help with binge eating. She also lowered my Parnate dose from 30 mg to 20 mg. I've never felt so let down by my pdoc. I feel like I have no hope with my binge-eating, which I'm not even sure if I have because I didn't get an official diagnosis of.

(bold 1) Not sure if this is what is going on, but Is this something she has to "see to believe"? If so, I fucking hate that.  BTDT sooo much in my life (including still happening).  It really feels degrading ... so I can relate to that.

(bold 2) Who is the "She" ... your pdoc? (the one who told you to stop taking the desipramine).  Did she give you a reason for lowering Parnate and stopping the desipramine?  Is desipramine a med you can just stop cold turkey?

 

Have you talked to her about this situation?  Maybe she needs to observe or whatever more to give you a diagnosis?  I don't think they would diagnose something in one day without whatever it is going on for awhile.  Doesn't give her the right to treat you the way she did though.

Are there any meds you are on that in combination, they might cause this increase in appetite?  ie Mirapex and Geodon, (hypothetical example) say for example the reaction when taking them together would cause you to eat more.  Do you think that is possible (I know they most likely do not do this, just randomly picked 2 meds you were on)?

I would tell her what you said in this post; maybe she has answers for you.  Personally I would not let all this all slide ... I would ask a lot of "Why" questions and not get BS answers.  Being dismissed (espec by a pdoc), it is like they don't believe me.  And I do not like feeling/being shot down.

I know in part what this type of thing feels like, being shot down so badly, so I can empathize.

[Wooster]

@mikrw33 I'm sorry you didn't get the help you wanted from your pharmacology oriented provider (psychMD). There are actually a lot of very helpful and effective treatments for binge eating symptoms that come from the psychotherapy end of things. I know that you've done the deep dive into meds. What are your thoughts about doing something similar for psychotherapy? Specifically I'm thinking about CBT or ACT (acceptance and commitment therapy) with someone who's got experience working with BED.

[Butterflykisses]

13 hours ago, mikrw33 said:

I've never felt so shot down by my pdoc before. She's usually so open-minded, but every single medication I mentioned she shot down, and she seemed completely dismissive about the fact that I could possibly have BED or NES. She didn't even put them on my list of diagnoses. I was really counting on her to help me with this. She offered me Adipex-P in place of Adderall, but it doesn't have the same mood-enhancing effects that Adderall has. Plus Adipex-P hasn't been proven to help with binge eating because it doesn't address the reward pathway in the mesolimbic pathway when you eat. I ugly cried the next day for at least an hour while my mom tried to console me. She wants to do anything she can to help me, but in the mind state I'm in, I don't feel like anything could help. She told me to stop taking desipramine which I thought would help with binge eating. She also lowered my Parnate dose from 30 mg to 20 mg. I've never felt so let down by my pdoc. I feel like I have no hope with my binge-eating, which I'm not even sure if I have because I didn't get an official diagnosis of.

So sorry your pdoc was dismissive...I recently had to find a new pdoc because my old one was too dismissive with my chronic psychosis.,,,my new one takes me seriously. Why did she lower your Parnate? I know in a blog you mentioned hoping she would increase it...?

[ktfergie]

let us know how it works out for you!!! 

[melissaw72]

@mikl_pls Was wondering how you are doing, and if you were able to get the naltrexone an any point after posting this, and if you got it, how is it working?

[mikl_pls]

I did get the naltrexone, just 50 mg of it though. I got it from my gdoc, who also prescribed me Bontril-PDM (phendimetrazine) for my appetite and weight loss (not working so well, think I'll either switch to Tenuate or Adipex-P next time).

[melissaw72]

3 hours ago, mikl_pls said:

I did get the naltrexone, just 50 mg of it though. I got it from my gdoc, who also prescribed me Bontril-PDM (phendimetrazine) for my appetite and weight loss (not working so well, think I'll either switch to Tenuate or Adipex-P next time).

I know you said the Bontril-PDM (phendimetrazine) wasn't really working so well, but is the naltrexone making a difference?  Or is it that both that aren't working ... asking because maybe taking them together has different effects than taking one over the other.

[mikl_pls]

On 3/4/2017 at 5:00 PM, melissaw72 said:

I know you said the Bontril-PDM (phendimetrazine) wasn't really working so well, but is the naltrexone making a difference?  Or is it that both that aren't working ... asking because maybe taking them together has different effects than taking one over the other.

 

Oh the naltrexone has definitely helped with my binge eating! That's for sure. The Bontril-PDM isn't helping much with weight loss, probably not as much had I gone with Adipex-P (phentermine).

[melissaw72]

8 hours ago, mikl_pls said:

Oh the naltrexone has definitely helped with my binge eating! That's for sure. The Bontril-PDM isn't helping much with weight loss, probably not as much had I gone with Adipex-P (phentermine).

That is great the naltrexone is helping your binge-eating!  I remember when I started it, it felt like such a relief that I wasn't binge-eating all the time anymore, and I even started feeling full.

[300.3]

Mik 

I'm using a phone right now so I can't see the full list of your meds but have you checked to see if anyone of them could possibly be altering  Ghrenlin levels?

I'm not an expert but I know a great deal of information on peptides. Your current meds can be altering Ghrenlin levels which would increase hunger..  I wouldn't be so quick to jump on the fact you have a disorder.  

Ghrenlin makes the calls and you have no choice but to follow.  This binge eating you describe can totally be explained by this peptide.  It's not in your control so it totally can be mislabeled as binge eating. 

I don't even think a typical dr or psychiatrist would even pick this connection up. 

I never comment on your posts because they usually are over my head lol.... but I read every one of your posts. BUT this one I had to comment on.

Don't rush for that diagnoses code so quickly. Something has changed . 

 

 

Edited March 7, 2017 by 300.3

[mikl_pls]

Well, you see, this has been a pattern for years, before I was medicated.

But I did research it though, and Zonegran does seem to increase ghrelin levels, however, it antagonizes neuropeptide Y, and I take Victoza which is a glucagon-like peptide 1 agonist, both of which reduce hunger. Zonegran is similar to Topamax in regards to being known for weight loss; however, it didn't ever affect me like that. Lamictal is supposed to cause some weight loss too.

[TakeAChillPill]

I never was able to understand why I binge eat either.  I know it's not physical hunger but thats about the majority of insight I can gather on the situation.  So for me it's not the hunger hormone.  

In the meantime I have a host of psychological quirks and emotional baggage to pick from.  I am pretty sure it's the melting pot of all my problems put together that make me eat that way sometimes but how am i going to untangle the entire mess and undo it so that I'm in control?  It seems impossible.  

I've been back on the dieting wagon fro a few days now and decided not to pursue bariatric surgery.  The idea of having the surgery and the aftereffects of the surgery were enough to catapult me into a serious dieting mindset at least for now.  I'll write more about this in my blog.  I think I've been "Scared straight."  

 

 

[300.3]

That's much different mik. I thought this was a byproduct of the meds .

takeachillpill

My close friend  had the procedure done. She continually has blood issues and needs B12 shots regularly because she gets so weak. She also had surgery to remove the excess skin

Edited March 8, 2017 by 300.3