Am Fam Physician. 2004;69(9):2225
Binge-eating disorder is characterized by uncontrolled consumption of large amounts of food. The differentiating characteristic between this disorder and bulimia nervosa is that patients do not follow binge eating with compensatory behaviors such as self-induced vomiting. Binge-eating disorder is common in patients who seek treatment for obesity. Persons with this disorder have higher rates of comorbid psychiatric disorders, especially depression. Treatment goals for patients who suffer from binge-eating disorder include cessation of binge eating, weight reduction, and improvement in any comorbid psychiatric disorder. Part of the multidisciplinary treatment of binge-eating disorder includes pharmacotherapy. Prior studies have shown that selective serotonin reuptake inhibitors have been successful in reducing the frequency of binge eating, but they do not promote weight loss. A new serotonin and norepinephrine reuptake inhibitor, sibutramine, has been shown to be effective in weight reduction and maintenance programs in short- and long-term studies. Appolinario and associates evaluated the efficacy and safety of sibutramine in the treatment of patients with binge-eating disorder.
The trial was a randomized, double-blind, placebo-controlled study of patients who met the criteria for binge-eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., and also met the definition of obesity based on their body mass index. Patients who met the inclusion criteria were randomly assigned to receive sibutramine in a dosage of 15 mg per day or placebo for 12 weeks. Patients were assessed at baseline and every two weeks during the study. Binge frequency, which was defined as the number of days with binge-eating episodes in the past week, was the primary outcome measure. Other outcome measures included scores on the Binge Eating Scale and the Beck Depression Inventory, weight changes, and treatment response (remission or response). Safety and tolerability of the medication also were evaluated.
Sixty patients were randomized to study groups; 23 in the sibutramine group and 25 in the placebo group completed the study. There was a significant reduction in the number of binge-eating days in the sibutramine group compared with the placebo group. The treatment group also lost substantially more weight than the placebo group. With regard to scores on the Binge Eating Scale and the Beck Depression Inventory, the sibutramine group had significantly lower scores than the placebo group. The main adverse reactions in the sibutramine group were dry mouth and constipation. Only two patients in the active treatment group withdrew from the study because of adverse effects of the medication.
The authors conclude that sibutramine is an effective medication in the treatment of obese patients with binge-eating disorders. In addition, this medication is well tolerated, with few adverse effects. Sibutramine therapy addresses the three main goals of treating patients with binge-eating disorder: binge eating, weight reduction, and treating comorbid psychiatric conditions.