Binge Eating Disorder Topamax.

Clinical studies show that people with certain medical conditions (besides epilepsy) can possibly benefit from Topamax. Binge eating disorder, a condition in which people eat unusually large amounts of food and feel their eating is out of control, may be treated with Topamax (although this is not an approved use of the drug). One particular study showed that the medication helped people with the disorder binge less often, lose more weight, and decrease their body mass index.

Zonisamide is a structurally and pharmacologically novel antiepileptic drug - a sulfamate-substituted monosaccharide - with proven anticonvulsant efficacy when used adjunctively in refractory partial epilepsy.10-12 Mechanisms hypothesized to account for zonisamide's antiepileptic properties include antagonism of voltage-gated sodium and T-type calcium channels, blockade of potassium-evoked glutamate release, modulation of central dopaminergic and serotonergic function, and carbonic anhydrase inhibition.10-16 Several lines of evidence suggest that zonisamide might be a useful treatment for BED. First, like the anticonvulsant topiramate,17-19 zonisamide has been associated with anorexia and weight loss in clinical trials in epilepsy patients10,11,20 and in patients with obesity.20 Topiramate has also been shown to reduce binge eating and weight in patients with binge eating disorder associated with obesity. Although zonisamide and topiramate have distinct pharmacologic profiles, both drugs share several pharmacologic actions. These include sodium channel blockade, carbonic anhydrase inhibition, and reduction of glutamate neurotransmission.

The prevalence of non-lethal self-injury among ED patients is approximately 25%, regardless of the type of eating disorder or the treatment setting (Eating Disorders 2002; 10:205). As for suicide attempts, the prevalence rates appear to vary, depending on the ED diagnostic subgroup and study setting. The prevalence of suicide attempts is lowest among outpatients with anorexia nervosa (16%). Prevalence rates are higher for bulimic individuals treated as outpatients (23%) and inpatients (39%). The highest rates of suicide attempts are reported among bulimic individuals who have comorbid alcohol abuse (54%) (Eating Disorders 2002; 10:205).

Binge eating disorder is believed to affect about 1% of women in the United States. It has been associated with obesity and about 30% of the individuals seeking weight-loss treatment have been found to be affected with BED. The important difference between BED and BN lies in the habit of purging, which is seen in BN but not in BED. BN patients attempt to get rid of the excessive calories consumed during a binge by purging, laxative use, fasting or by excessive exercise. BN affects about 6% of American adolescent girls.

Bottom Line: Topiramate appears to be effective in the treatment of binge eating disorder associated with obesity. However, nearly one half of the study participants dropped out for various reasons, including adverse events, lack of treatment efficacy, or treatment nonadherence for unclear reasons.

PET scanning (=positive emission tomography) is expensive and is currently only used as a research tool or in life threatening clinical situations. In Ref.13 this tool has been used to document that in a group of women with binge eating disorder there was an altered blood flow pattern in the brain when their appetite was stimulated by images of food. There was more blood perfusion in the left hemisphere and the left frontal lobe of this group compared to normal-weight controls having normal eating habits. This observation may have far reaching therapeutic significance for future treatment approaches.

One study published in the March 2003 edition of the American Journal of Psychiatry suggested that Topamax is effective for binge eating disorder treatment. In this study, obese people with binge eating disorder taking Topamax showed greater improvement, compared to those not taking the medication. Those taking Topamax binged less often, lost more weight, and decreased their body mass index (BMI). On average, people taking Topamax lost about 13 pounds over 14 weeks.

describes an Oxford University study by Fairburn et al., where 150 patients with either bulimia nervosa or binge eating disorder were followed over a 5-year period without intervention. Patients with bulimia nervosa were shown to have a poor prognosis with about 40% still having an eating disorder or obesity after 5 years. In contrast the binge eating disorder group showed a much better prognosis with a spontaneous cure rate of 80%.

Topiramate (Topamax) -- There is evidence that this anticonvulsant which is also used (off-lablel) in bipolar disorder helps control appetite and helps people lose weight. There is currently a controlled study evaluating the efficacy of this medication in binge eating disorder.

Topiramate (Topamax): There is evidence that this anticonvulsant which is also used (off-label) in bipolar disorder helps control appetite and helps people lose weight. There is currently a controlled study evaluating the efficacy of this medication in binge eating disorder .

Topamax is approved only for treatment of epilepsy and migraines. However, it has also been investigated as a treatment for obesity, especially binge eating as well as alcoholism and for some psychiatric conditions like bipolar disorder. A study in the Annals of General Psychiatry found that topamax does not help in the treatment of acute mania, but may have a place in the treatment of binge eating, alcohol dependence and possibly bipolar disorder.

This paper shows that the anticonvulsant medication topiramate (brand name: Topamax) was effective in reducing weight in a group of patients with binge eating disorder at a dosage of 400 to 600 mg daily. You may want to discuss this with your doctor. If this medication is used, one has to slowly start the dose and work up to the above mentioned maintenance dose and at the end of treatment slowly wean the medication to avoid seizures. There are a number of neurological side-effects, which your doctor could explain to you. However, any treatment decisions are strictly between you and your doctor. Just because one study says that a new treatment modality is effective does not mean that this would be the best treatment in your case.

Topiramate may not be suitable for persons with a history of liver or kidney disease, mental illness, high blood presure, angina (chest pain), irregular heartbeats, or other heart problems. Before beginning treatment with topiramate, patients should notify their physician if they consume a large amount of alcohol, have a history of drug use, are pregnant or planning on becoming pregnant.

Topiramate is a broad-spectrum neurotherapeutic agent that has been approved for use as an adjunctive therapy in the treatment of partial-onset seizures in adults. Its mechanism of action is not fully understood, but the drug is known to enhance g-amino butyric acid (GABA) activity, to block voltage-dependent Na+ channels, to antagonize kainate and AMPA glutamate receptors, and also to inhibit carbonic anhydrase. Well-tolerated in clinical trials, topiramate’s most common adverse effects are somnolence, dizziness, ataxia, speech disorders, psychomotor slowing, and paresthesias. Additionally, a retrospective review of epilepsy patients treated with topiramate suggests that it may be associated with reduced appetite and weight loss (5).

There is increasing interest in the use of topiramate to treat some psychiatric disorders, and preliminary reports have already suggested that topiramate may have mood-stabilizing properties in patients with bipolar disorder (6,7). In the field of eating disorders, Shapira and others published an open-label trial on topiramate use (100 to 1400 mg daily) in 13 patients with BED (8). Eleven patients responded with a moderate-to-marked reduction in binge eating frequency and associated weight loss.

About 20 sites across the country are beginning trials to further test topiramate for binge-eating disorders that are associated with obesity. Researchers are hoping to enroll 360 patients. Topiramate is FDA approved for epilepsy.

For bulimia nervosa, medications are used to reduce the frequency of disturbed eating behaviors such as binge eating and vomiting. Medications are often used to improve symptoms that may accompany depression, anxiety, or obsessive behaviors. The medications used in the treatment of bulimia nervosa include antidepressants, the antipsychotic drug lithium, and the anticonvulsant drug topiramate (brand name: Topamax). Although lithium is now falling out of favor due to ineffectiveness in bulimia nervosa, its side effect of weight gain, and need of frequent blood monitoring to avoid toxic drug levels. The long-term benefits of using antidepressants for bulimia nervosa are unclear, as relapse rates are high with up to 80% of patients relapsing.

BACKGROUND: Experts say binge eating disorder is probably the most common eating disorder, affecting as many as 4 million Americans. It is characterized by recurrent episodes of over eating without starving (anorexia) or purging (bulimia). This disorder is usually associated with being overweight and is very commonly associated with other psychiatric illnesses. There are some rare genetic disorders and medications that may induce binging. Psychiatrist Nathan Shapira, from the University of Florida in Gainesville, says, "There's a tremendous need for help with binge eating disorder. It's common. It's disabling for many people. It controls their life. Any effective medicine that would help with this disorder would be incredibly useful." Currently, there are no FDA-approved treatments for binge eating disorder.

In studies, Topamax was shown to be effective for treating binge eating disorder. This eMedTV Web page discusses Topamax and binge eating disorder in more detail, including an explanation of what binge eating is.

Untreated SRED is usually unremitting. Many report that their symptoms have been dismissed by other physicians or wrongly attributed to a mood disorder. Not surprisingly, patients in obesity clinics and eating disorder groups regularly report SRED.