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Treatments and drugs
By Mayo Clinic staffThe goals for treatment of binge-eating disorder are to reduce eating binges, improve your emotional well-being and, when necessary, to lose weight. Because binge eating is so entwined with shame, poor self-image, self-disgust and other negative emotions, treatment needs to address these and other psychological issues.
There are four main types of treatment for binge-eating disorder.
Psychotherapy
Psychotherapy, whether in individual or group sessions, can help teach you how to exchange unhealthy habits for healthy ones and reduce bingeing episodes. But definitive scientific research about the benefits of psychotherapy remains lacking. Some studies do show that a few types of psychotherapy may be helpful, including:
- Cognitive behavioral therapy. Some studies show that cognitive behavioral therapy may help you cope better with issues that may trigger binge-eating episodes, such as negative feelings about your body or a depressed mood. It may also give you a better sense of control over your behavior and eating patterns. However, cognitive behavioral therapy hasn't been shown helpful in reducing weight. So if you're overweight, you may need additional treatment.
- Interpersonal therapy. Interpersonal therapy focuses on your current relationships with other people. This may help reduce binge eating that's triggered by poor relationships and unhealthy communication skills. The goal is to improve your interpersonal skills — how you relate to others, including family, friends and colleagues. You learn how to evaluate the way you interact with others and develop strategies for dealing with relationship and communication problems.
- Dialectical behavior therapy. This form of therapy can help you learn behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others, all of which can reduce the desire to binge eat.
Medications
There's no medication specifically approved by the Food and Drug Administration (FDA) to treat binge-eating disorder. And research results about the effectiveness of medications to treat binge-eating disorder have been mixed. Some studies show that combining therapy with medications may be more effective than either treatment alone. But more studies are needed before drawing firm conclusions. However, some studies show that several types of medications may be helpful, including:
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Antidepressants. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may be helpful for binge eating. It's not clear how these can reduce binge eating, but it may be related to how they affect certain brain chemicals associated with mood.
Be aware that all antidepressants have potentially harmful side effects. In particular, antidepressants have an FDA-mandated black box warning about their possible connection to increased thoughts of suicide. If you take antidepressants, you must be carefully monitored for such thoughts, especially when you first start treatment or have any changes in dosage.
- The anticonvulsant topiramate (Topamax). Normally used to control seizures, topiramate has also been found in some studies to reduce binge-eating episodes. However, it can cause serious side effects, including blurred vision, double vision, clumsiness or unsteadiness, dizziness, drowsiness, and trouble in thinking.
- The anti-obesity medication sibutramine (Meridia). Officially included in the group of antidepressants known as serotonin and norepinephrine reuptake inhibitors (SNRIs), sibutramine has been FDA approved for long-term obesity treatment. Sibutramine may be most helpful if you have binge-eating disorder and are obese. It's been found to suppress hunger and make you feel full, leading to weight loss. However, it can cause dangerous changes in your blood pressure and other side effects.
Behavioral weight-loss programs
More so than psychotherapy, weight-loss programs focus on losing excess body weight. They're typically conducted under medical supervision to ensure that your nutritional requirements are met. Some programs are known as very low calorie diet programs because they include an initial period of strict calorie restriction for fast weight loss.
Weight-loss programs may also address issues that tend to trigger binges, but often to a lesser extent than psychotherapy does. However, weight-loss programs, especially those that are not medically supervised, may not be appropriate for everyone with binge-eating disorder. And such programs typically aren't recommended until the binge-eating disorder is treated. Very low calorie diets can trigger more binge-eating episodes making the condition worse.
Self-help strategies
Some people with binge-eating disorder find self-help books, videos and support groups effective. Some eating disorder programs offer self-help manuals that you can use on your own or with guidance from mental health experts. Self-help strategies may not be effective on their own, though. You still may need professional treatment with psychotherapy or medications.
