Key takeaways
Vyvanse is the only FDA-approved medication specifically for treating binge eating disorder (BED), working by controlling impulsivity and increasing dopamine and norepinephrine levels in the brain.
Lisdexamfetamine, the active ingredient in Vyvanse, has shown in clinical studies to reduce the number of binge eating days per week and lead to weight loss, but its appetite-suppressing side effect may not be suitable for all patients.
Psychiatrist Jared Heathman notes that Vyvanse has been effective in treating BED by reducing symptoms of impulsivity and inattention, with a clinical trial indicating a lower relapse rate six months post-discontinuation.
While Vyvanse is a leading treatment for BED, alternatives like cognitive behavioral therapy (CBT), antidepressants, and Topamax offer other options for managing the disorder, highlighting the importance of a comprehensive treatment plan.
Binge eating disorder (BED) is characterized by episodes of eating large amounts of food over a short period of time. Individuals with this condition may feel as though they cannot control how much they are eating during an episode. They may overeat even when they are not hungry or are past the point of feeling full. Distress, guilt, shame, anxiety, or depression about how much they have eaten is common. Binge eating disorder is the most common and one of the most fatal eating disorders in the United States, according to the National Eating Disorders Association (NADA). Vyvanse is one treatment option to help people control binge eating behavior.
What is Vyvanse?
Vyvanse is the brand name for a medication called lisdexamfetamine dimesylate. It is a central nervous system stimulant that has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of attention-deficit hyperactivity disorder (ADHD) in adults and children as well as severe binge eating disorder (BED) in adults. Vyvanse is a prescription drug available in capsule and chewable tablet form.
How does Vyvanse work for binge eating?
Vyvanse is the only FDA-approved medication to treat binge eating disorder. The use of Vyvanse can help control the impulsivity associated with binge eating. Vyvanse works by slowly increasing the levels of dopamine and norepinephrine in your brain.
CNS stimulants like Vyvanse improve the processing speed and cognitive function of the brain. This can help with the decision-making process to stop eating and to only eat when hungry. In evidence from a systematic review and meta-analysis of all relevant clinical studies, lisdexamfetamine has been shown to reduce obsessions, compulsions, and the number of binge days per week, leading to weight loss.
Individuals should be aware that lisdexamfetamine can cause a decreased appetite. Depending on an individual’s treatment goals and propensity toward food restriction, this side effect may be helpful or harmful, so should be monitored by a healthcare provider.
Other classes of stimulant amphetamines that are used to treat ADHD are not used in the treatment of binge eating disorder.
How effective is Vyvanse for binge eating?
“Vyvanse has been quite beneficial in treating binge eating disorder in my experience,” says Jared Heathman, MD, a psychiatrist based in Houston. Vyvanse is widely recognized in the field of psychiatry as an effective treatment for reducing symptoms of impulsivity and inattention that occur in ADHD as well as during overeating. When compared to placebo, Vyvanse has also repeatedly demonstrated clinically meaningful short-term reductions in binge eating frequency and obsessive thoughts and compulsive behaviors around binge eating. Additionally, in a clinical trial published in JAMA Psychiatry, individuals taking Vyvanse were less likely to relapse six months after discontinuing the medication.
Vyvanse dosage for binge eating
Vyvanse is approved for the treatment of moderate to severe BED in adults only. Stimulant medications like Vyvanse typically have a rapid onset of action and begin working in the brain quickly. Lisdexamfetamine is a pro-drug of dextroamphetamine. After taking the medication, lisdexamfetamine is rapidly absorbed by the gastrointestinal tract and converted to dextroamphetamine, which is the active form of the drug. According to pharmacokinetic data, peak concentrations of the medication can typically be found in serum after two to four hours.
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Vyvanse is available in the following forms and strengths:
- Capsules: 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg
- Chewable tablets: 10 mg, 20 mg, 30 mg, 40 mg, 40 mg, 50 mg, 60 mg
The typical starting dose of Vyvanse for BED is 30 mg, by mouth, taken once per day in the morning. This dosage can then be increased in 10 to 20 mg increments until the best dosage is found for each individual. This may take several weeks. The maximum dosage is 70 mg per day. Your healthcare provider will evaluate impulse control, overall mood, and success with reducing binge eating episodes to help determine the correct dose for you.
RELATED: Signs your Vyvanse dose is too high
Vyvanse side effects
For most individuals, Vyvanse has a well-tolerated side effect profile. The most common Vyvanse side effects reported are:
- Dry mouth
- Restlessness
- Insomnia
- Decreased appetite
- Increased heart rate
- Constipation
- Feeling jittery
- Anxiety
Vyvanse will not make binge eating worse. Some individuals will experience significant weight loss while taking this medication as they reduce or eliminate binge eating episodes and/or experience the side effect of reduced appetite. Vyvanse is not an appetite suppressant and Vyvanse should not be used for the sole purpose of losing weight or in the treatment of obesity outside of the context of binge eating disorder.
Vyvanse is also associated with some very serious side effects including psychosis, manic symptoms, sudden death, heart attack, rapid heart rate, high blood pressure, stroke, and other heart problems. “Because of its cardiac effects, the patient should be screened for cardiac contraindications,” Dr. Heathman says.
RELATED: Vyvanse side effects in males | Vyvanse side effects in females
Warnings and restrictions
Potential for abuse
As a controlled substance, Vyvanse has a boxed warning, the most stringent warning the FDA issues for medications, for the high potential for abuse. Healthcare professionals should assess the risk of abuse prior to prescribing this medication and monitor for signs of abuse and dependence while on therapy.
Serious cardiovascular reactions
Sudden death, stroke, and heart attack have been reported in association with CNS stimulant use at recommended doses in adults. Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart arrhythmia, or coronary artery disease. Blood pressure and heart rate should be monitored. Consider benefits and risks before use in patients for whom blood pressure increases would be problematic.
Psychiatric adverse reactions
This medication may cause psychotic or manic symptoms in patients with no prior history or exacerbation of symptoms in individuals with pre-existing psychosis. Evaluate for bipolar disorder prior to stimulant use.
Peripheral vasculopathy, including Raynaud’s phenomenon
Stimulants are associated with peripheral vasculopathy, including Raynaud’s phenomenon. Careful observation for changes in fingers or toes is necessary during treatment with this medication.
Serotonin syndrome
There is an increased risk of serotonin syndrome when this medication is taken with serotonergic agents (MAOIs, SSRIs, SNRIs, triptans) and in overdose. This is a medical emergency. Vyvanse should be immediately discontinued, and supportive treatment should be initiated.
How to get prescribed Vyvanse for binge eating
Vyvanse should only be prescribed by a mental health professional, such as a psychiatrist with a DEA license, and used in conjunction with cognitive behavioral therapy (CBT). Making an appointment to see a licensed mental health professional will be the first step in getting help with binge eating disorder.
- See a licensed mental health professional for approval of Vyvanse.
- Your mental health professional will do a complete medical history asking about any medications you are taking or have taken in the past, your health history, your family’s health history, and screen you for any contraindications.
- Your mental health professional will take a complete mental health history, asking about your mood, feelings, substance use, and other questions that will help them understand any current or previous psychiatric treatment you may have had.
- You and your mental health provider will discuss your eating habits in detail to determine if you have a form of disordered eating and if so, what the best treatment options might be. They may ask you about why you eat food, when you eat food, how much food you eat, what types of food you eat, and how you feel during and after an eating episode.
- Your healthcare provider will then use all this information to determine if a Vyvanse prescription is right for you while working in a multidisciplinary team to address other health problems that may be a result of BED.
Alternatives to Vyvanse for binge eating
Vyvanse may not be the right medication for everyone who needs help with binge eating disorder. While Vyvanse is the only medication FDA approved for this indication, other medications and therapies are available.
CBT
Many individuals with binge eating disorder also have anxiety disorders, depression, other forms of disordered eating, and/or poor self-image or self-worth. CBT is a type of talk therapy that helps individuals identify underlying dysfunctional thought and behavior patterns and employ strategies to change or overcome them. Most medical professionals and data strongly support therapist-led CBT as a cornerstone of treatment for binge eating disorder.
Antidepressants
Antidepressants in the class of selective serotonin reuptake inhibitors (SSRIs) are also used to treat binge eating disorders. Binge eating disorder is often present with other conditions that respond well to antidepressants, such as depression, anxiety disorders, and obsessive-compulsive disorder. In an analysis of the limited available data, SSRIs led to greater rates of reduction in binge eating, psychiatric symptoms, and weight when compared to placebo.
Topamax
Topamax (topiramate) is an antiepileptic medication with appetite-suppressing side effects. Topamax affects the main excitatory neurotransmitter, glutamate, as well as neuropeptide Y, which has an important role in controlling food intake. Its use in the treatment of binge eating disorder has been associated with a reduction in binge frequency, binge day frequency, obsessions, compulsions, BMI, and weight.
Other medications for binge eating disorder |
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Drug name | Drug class | Standard dosage | Common side effects | Coupons |
Vyvanse (lisdexamfetamine dimesylate) | CNS stimulant | 30-70 mg taken once per day | Nausea, dry mouth, insomnia | Vyvanse Coupons |
Topamax (topiramate) | Anticonvulsant | 25-100 mg taken once per day | Drowsiness, headache, paresthesia | Topamax coupons |
Prozac (fluoxetine) | SSRI | 60 mg taken once per day | Nausea, constipation, headache | Prozac coupons |
Paxil (paroxetine) | SSRI | 20-50 mg taken once per day | Nausea, dry mouth, dizziness | Paxil Coupons |
Zoloft (sertraline) | SSRI | 50-200 mg taken once per day | Insomnia, diarrhea, dry mouth | Zoloft coupons |