Monday, February 9, 2015

Why I’m worrying about Vyvanse and Binge Eating Disorder

Seeming quick fixes can be so tempting.
This week’s inbox held the following message from an old patient:

“I was watching Good Morning America and they had Monica Seles on, admitting she's suffered from binge eating disorder (BED). They announced a medication they are now using to treat BED, Vyvanse, also used for ADHD. I looked it up and side effects include weight loss. Have you ever recommended this drug for BED? Do you feel it is effective for BED? Can people with BED take this med to lose weight? Do they think if you have BED you must be overweight and this medication can cause weight loss? Which would perhaps (in their minds) solve the bingeing?

That small ED voice that lurks deep from within is screaming 'get me that drug! Get me that drug!' so I can lose weight. WTH?!"

I’m glad she was brave enough to share what she was wondering, as I’m sure she’s not alone in her curiosity. Aren’t you wondering what this means for you?

Let's start by clarifying a few things about binge eating disorder. Most notable about BED is the recurring episodes of binge eating, feeling out of control while binging, and feeling guilt and shame afterward. People of all sizes live with BED, and the experience of a binge may vary. You might eat large amounts of one itemsuch as a whole package of cookies—or large amounts from a combination of foods. For some, even eating a single bite beyond what they intended may feel like a binge.
There's a way off the roller coaster--appropriately
named the Cyclone.

The common features among sufferers, though, is the guilt, shame and lack of control accompanying the eating. According to the Binge Eating Disorder Association,  "Binge Eating Disorder (BED) is the most common eating disorder in the United States. An estimated 3.5% of women, 2% of men, and 30% to 40% of those seeking weight loss treatments can be clinically diagnosed with binge eating disorder. The disorder impacts people of all races, levels of education and income — including adults, children and adolescents."

Given the shame associated with BED, however, there are likely many more living with the condition than we know.

Medication to the rescue?

Two recent studies were done using Vyvanse—a stimulant used to treat ADHD—for the treatment of moderate to severe binge eating disorder. They were well-done studies— randomized, double-blind and placebo-controlled—with promising outcomes. 

In one study, participants who binged three or more times per week were treated with either a placebo—a dummy pill—or 30, 50 or 70 mgs/day. Researchers saw a significantly better response to the 50 and 70 mgs/day doses compared to placebo in a study of over 250 subjects with a roughly equal number of controls. Improvements included reduction in binge frequency/week, a higher percent of subjects binge free for 4 weeks, and a change from baseline in the Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating—compared to placebo treatment.

Notable, however were a couple of other outcomes. The placebo group also improved, by 21.3 percent (versus 42% in the 50 mgs/day and 50% in the 70 mgs/day treated groups). Meaning, the belief that taking something could help your binge eating was enough to improve binge frequency.

And then there were the side effects. More than 5% of those treated with Vyvanse reported symptoms including “dry mouth, insomnia, headache, decreased appetite, nausea, irritability, heart rate increased, anxiety, feeling jittery, constipation, hyperhidrosis [excessive sweating].” Twelve patients (5%) on Vyvanse reported treatment-related adverse events that led them to stop the study; 5 patients in the placebo-treated group had such negative effects. 

And then there’s this: “CNS stimulants (amphetamines and methylphenidate-containing products) have a high potential for abuse and dependence.” 

If you struggle with Binge Eating Disorder and are tempted by the positive research results, consider the following before you request a prescription. While medications might improve binge eating, so does addressing some underlying eating patterns and thoughts—without the risks of medication. In fact, since the placebo also improved binge frequency by over 21%, it suggests that the power of believing you could change—with some help—is quite strong with BED.

Yes, there's hope without meds for BED!

Need I say more?

Do any of the following scenarios apply to you? If so, medications for BED may be unnecessary.
  1. You restrict your calories throughout the day, trying to be “good”. You deny your body the fuel it needs and by later in the day—often late afternoon or at night—you start eating, intending to eat in control. But then it feels like the flood gates open and you just can’t stop. Perhaps you feel like you’ve already blown it, so feeling defeated, you decide to continue to binge. You’re determined to get back on track tomorrow—with restricting. And so the cycle continues.
  2. You eat enough calories throughout the day, but your food choices are very limited—including only foods you "should" be eating based on rules you follow; they may be only high protein, or unprocessed or not very palatable. They are foods that you’re okay with, but that don’t necessarily give you much pleasure. Then, when at a friend’s or out to eat and you eat something to appear ‘normal’ or because you really want it, you have serious regret. Later you continue eating because you’ve already "ruined it", but are determined to get back to your very restrictive, healthy food choices.
  3. You truly get enough to eat—enough calories and enough of foods you really enjoy. But most of your eating is quite mindless—you eat standing up in the kitchen, while multitasking—while driving, on the computer or on the phone. So you never truly feel satisfied. And it’s worse when food is kept in sight.
  4. You eat enough, you get what you want to eat, AND you pay attention to eat mindfully. But when stress if high, or you struggle with an emotion that’s hard to sit with, your knee-jerk reaction is to reach for food for comfort or to numb out. You may even be completely aware of what you’re doing, but the pull is so strong, because in the short run, it helps. But later, you are left with regret.
If any of the above statements apply, then working with an eating disorder dietitian—together with a therapist can really help. Cognitive Behavioral Therapy (CBT) is a valuable, well-studied treatment for BED, and you can purchase self-help workbooks specifically for this condition as well. 

Learn to normalize  your eating!
Yes, binge eating can be resolved without medication. But it requires dropping the diet and rigidity around eating. Really, dieting simply isn't helping.

For those with ADHD who also binge eat, the medication may be helpful to manage impulsivity—which can lead to binge eating. Delayed gratification—redirecting and waiting to notice fullness—can be too challenging, as is moving away from multitasking.

But using Vyvanse is not without consequences. Decreased appetite may sound appealing but if you don’t know when you’re hungry, it's hard to trust when and how much to eat — making intuitive eating impossible. It may contribute to inadequate intake and food restriction—something those struggling with binge eating may already struggle with. 

Do we need to swap one problem with another?

Further, will doctors inappropriately start prescribing Vyvanse for those who are overweight but not living with moderate to severe BED? Will prescribing seem like the medical quick fix, while failing to address restrictive eating, or deprivation or over-exercising that truly need treatment? 

So, dear readers, please don’t be tempted. But don’t give up hope. Seek out providers that work with binge eating disorder patients because it is in your hands to change.

Other related links you might find helpful:


  1. It amazes me how you completely dismiss the addictive tendencies of binge eaters. Binges are caused by chemical reaction in the brain/body to sugary/salty/fatty/carb-y foods (Put it simply: no one binges on baked chicken breast), and also by emotional eating:no one has a bad day at work and comes home and steams a pound of broccoli and opens three cans of tuna and shovels it down. Do you ever tell an alcoholic to normalize alcohol?

    1. Truth be know, people can and do binge on anything--although foods that are easiest to access, more challenging to portion, and viewed as forbidden are far more common binge foods. Yes, patients have reported bingeing on whole grain bread and in fact, unsalted nuts--which, for the record--are high in protein--particularly in the portions they've eaten them. I have had patients with BED binge on apples--although that one surprised me and also on foods the world would view as healthy and unprocessed. Steamed broccoli--well, that requires some delayed gratification--you have to wait to steam it--but patients have microwaved several large bags of frozen veggies and so-called baby carrots. The act of bingeing knows no boundaries.

    2. I just wanted to say, thanks for the article and the comments. I would also like to give my opinion:
      To clarify: bingeing on nuts is appealing because of their hight FAT and (in large amounts, especially with certain nuts like cashews) high CARB content, NOT protein. almost all binge eaters (myself included) focus on anything high fat and high carb because there truly is an imbalance of serotonin that makes those foods not just appealing, but addictive, and eating them provides an instant calm and sense of relief, much like what I assume drug and alcohol addicts feel when they engage in their own destructive behaviors . If people are bingeing on baby carrots or steamed veggies, it isn't because they crave them, but probably because its all the've got left in the house. ( I speak not from a judgmental standpoint, but from experience of doing this myself)
      In response to the rest of this article, while I Certainly agree that CBT and other therapies provide a world of help, sometimes they just don't do the trick. Certainly, some of your other suggestions, such as eating enough throughout the day of foods you actually ENJOY, does help. However, its such a fine line between eating them in moderation, and going overboard. It is seemingly impossible to find a balance. Eating disorders are the only addiction that you constantly have to face every day, you can't say you'll just never eat again, like addicts can do with drugs or alcohol - ED's are like a pet dragon you have to carry around and feed 3-5 times a day, while still trying to avoid letting it breathe fire on you.
      As someone who has tried lots of different SSRI's, SNRI's, talk therapies, and even a treatment facility, I will say that they can certainly Help, but even as someone who managed to go b/p free for an entire year, the obsessive thoughts never left me. it has been so hard, to think that maybe they would never go away. I tried Vyvanse out of desperation, and didn't even take the entire 30mg (which is the lowest dose) as prescribed. I only take 10-15mg now, and it has been a life changer. I DO not get the accelerated heart rate, meth'd out feeling that I know can come with these meds, even at 30mg. at this small of a dose- it simply helps me focus and takes away those disastrous obsessive thoughts. For me, it's worth it. Just my two cents.

  2. GREAT offering Lori….Thank you for sharing this with those of us "who-would-be" tempted…Your former client was courageous and generous in sharing the "pull" such medications can provide for heading in the wrong, opposite way of recovery….Before having finished her first message to you concerning Vyvanse…I horribly found myself with pencil in hand…just waiting for the end of the article to note and later find something …a miracle "substance" to make the current "substance" (food ) addiction abate.

    The real work does go on…placebo-style …in the mental exercise, developed habit of believing that WE…inside have a hand in what we actually do or do not do. Gwenyth on Your Eatopia speaks often, and wisely, of the "Whack-a-Mole" strategies we unknowingly (or knowingly) use to transfer one "numbing" device to another…

    Thanks to you both (you and your brave, honest patient) for this wake-up call.

  3. Interesting. I think I had a problem with binge eating before I started
    seeing my psychiatrist. I was already seeing a therapist, but wasn't really
    on the front burner because other issues were more important to me to deal
    with at the time. Most often, if I binged, it would be on like a package of
    nutter butter bars (mmmm). It wasn't just for the sake of eating it--I
    seriously enjoyed (and still do) not only the taste but pure texture of
    feeling those things against my teeth, gums, etc... So I didn't exactly
    numb out with it, but it was comforting. And I did always feel ashamed

    But since my psychiatrist put me on bubpropion for depression, one of the
    side effects is loss of appetite. I've been so pleased with that side
    effect. I no longer feel controlled by food, I don't feel hungry "all the
    time," and I don't feel threatened by sweets kept in the house. If we have
    a box of cookies, it stays as a box of cookies for weeks. Heck, we even
    keep a cookie jar full of halloween candy on the counter (mostly
    chocolate!), and it's all actual halloween candy from october! It is such a
    relief to feel like I'm in control, even if it's just the medicine that's
    doing it. I'm not bothered and distracted by food anymore.

    So at least for me my medication worked very well for my emotional eating
    problem, even if it wasn't intended for that. I'm skeptical about the med
    in this post though.

  4. I take Adderall for ADHD and it makes you not want to eat at all. But wasn't this attempted already in the 1960s?

  5. So I have a BED diagnosis, and two weeks ago, with the blessing of my therapist (a LCSW), I started taking Vyvanse. I am not yet on a therapeutic dose (I see my doctor on Monday for a med check), but I am hopeful that this tool, ALONG WITH continued individual and group therapy, can help me with what has become a hopeless situation for me. Even on the lowest dose, I have seen improvements in the number of binge days I experience each week. I had gotten to the point that I was binge eating at almost every meal, and the depths of my depression had reached a terrible point. While I agree that medication might not be right for everyone, there are those of us out there who might be helped by Vyvanse, and I, for one, am thankful that my therapist and physician were willing to have me try it.

    1. I'm pleased it's beginning to help! I caution you when you are at a therapeutic dose and appetite gets suppressed, particularly if you don't have an ED RD on board.