An open-label trial on the efficacy and tolerability of naltrexone/bupropion SR for treating altered eating behaviours and weight loss in binge eating disorder

Carbone, Elvira Anna; Caroleo, Mariarita; Rania, Marianna; Calabrò, Giuseppina; Staltari, Filippo Antonio; Filippis, Renato de; Aloi, Matteo; Condoleo, Francesca; Arturi, Franco; Segura-Garcia, Cristina

doi:10.1007/s40519-020-00910-x

Cited by 38 publications

(42 citation statements)

References 64 publications

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“…According to these authors, both obesity and drug addiction are examples of major disorders characterized by dysregulated control systems. To date, this information has not been integrated into mainstream ED treatment programs, possibly because the translation of these findings contradicts the popular assumption that “it’s not about the food.” No trials have been conducted using strategies designed to reduce reward-based eating in patients with EDs; however, there are data suggesting that medications commonly used in SUD treatment (naltrexone/bupropion) in conjunction with lifestyle changes can reduce FA severity among those with BED [ 97 ]. Prospective research is needed to determine if reduction of highly palatable foods can improve reward dysfunction in people with FA.…”

Section: Substance Use Disordersmentioning

confidence: 99%

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Wiss

Brewerton

2020

Nutrients

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Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction “diagnosis” among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or “the signal”) from the more classic eating pathology (true negatives, or “restraint”) that can potentially elevate food addiction scores (false positives, or “the noise”). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.

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Section: Substance Use Disordersmentioning

confidence: 99%

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Wiss

Brewerton

2020

Nutrients

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“…Three studies were RCT’s, in two of which the control groups were placebo [ 31 , 36 ] and the other study was an intervention with a food image inhibition training task with the control group receiving no specific instructions or restrictions on viewing images [ 37 ]. Three studies included a control group; however, were not randomly assigned [ 25 , 38 , 39 ]. These control groups included patients that had obesity without BED [ 38 ], no treatment [ 39 ], or a “Usual Care” method which included a multidisciplinary weight management clinic [ 25 ].…”

Section: Resultsmentioning

confidence: 99%

Current Intervention Treatments for Food Addiction: A Systematic Review

Leary

Pursey

Verdejo-García

et al. 2021

Behavioral Sciences

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Research on the concept of food addiction (FA) has steadily grown and, based on a widely used self-report, FA is estimated to affect between 16–20% of the adult population. However, there are few interventions available for people with self-reported FA, and their efficacy is unclear. The primary aim of the review was to examine the efficacy of different interventions, including behavioural/lifestyle, medication and surgical approaches, for reducing symptoms and/or changing diagnosis of FA among adolescents and adults. A secondary aim was to examine the influence of sex as a moderator of intervention effects. A systematic search was performed from 2008–2020 to identify studies that used the YFAS to assess the effectiveness of interventions on FA. Nine studies were identified (n = 7 adults, n = 2 adolescents) including a total of 812 participants (range 22–256) with an average of 69% females per study. The types of interventions included medications (n = 3), lifestyle modification (n = 3), surgical (n = 2) and behavioural (n = 1), with FA being assessed as a secondary outcome in all studies. Five studies in adults reported a significant reduction in FA symptoms or diagnosis from pre to post-intervention, two when compared to a control group and three in the intervention group only. Efficacious interventions included: medication (combination of naltrexone and bupropion, as well as pexacerfont), bariatric surgery and lifestyle modification. No significant changes in FA were reported in adolescent studies. Given few studies were identified by the review, there is insufficient evidence to provide clear recommendations for practice; however, some interventions show potential for reducing self-reported FA outcomes in adults. Future research should explore the longer-term efficacy of interventions and the effectiveness of treatments with sufficient sample sizes.

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“…Studies with other classes of antidepressants, such as SNRIs (105) and bupropion (106), have shown discordant results on binge improvement or weight loss in BED. More recently, the association of naltrexone/bupropion (extended release) has proved to be effective in reducing BMI and altered eating behaviors in obese patients with BED in a 16-week study (107); however, the authors did not find changes in depressive symptoms. Herein, although depressive symptoms improved, they did not affect the improvement in binge eating outcomes, that most likely improved by virtue of the multimodal targeted action of VTX on the serotoninergic pathways.…”

Section: Efficacy Of Vtx On Bmi and Eating Disordermentioning

confidence: 97%

Naturalistic and Uncontrolled Pilot Study on the Efficacy of Vortioxetine in Binge Eating Disorder With Comorbid Depression

et al. 2021

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Background: Binge eating disorder (BED) is clinically relevant by virtue of the global impairment, poor quality of life, and increased overall medical morbidity. The high comorbidity with psychiatric disorders, particularly depression, has received attention as a possible mediator of the poor outcome. Further, BED and depression share cognitive dysfunctions. This naturalistic and uncontrolled pilot study aimed at evaluating the efficacy of vortioxetine (VTX) on depressive symptoms in patients with BED, secondly the efficacy in improving a broad array of executive functions, and third to explore the effect on eating behavior and body weight.Methods: This pilot study involved 30 patients with BED and comorbid MDD, treated with VTX for 24 weeks. Assessments were run at baseline (t0), 4 (t1), 8 (t2), 12 (t3), and 24 (t4) weeks. Changes in depressive symptoms (HDRS and BDI), executive functions, eating behaviors (binge frequency and severity, night eating, food addiction), and body weight were estimated after treatment with VTX through GLM.Results: Significant improvements emerged after treatment with VTX in: depression (HDRS p < 0.001; BDI p = 0.002) regardless the dose of VTX and first diagnosis (BED/MDD), working memory (RAVLT acquisition p = 0.01, delay recall p < 0.001, RCFT percentage of recall p = 0.01, and Attentional Matrices p = 0.05), binge days frequency (p < 0.001), binge eating severity (BES p < 0.001), night eating (p = 0.001), food addiction (YFAS 2.0 p = 0.039), and body weight (p = 0.039). The improvement in depressive symptoms was associated with the concurrent improvement in night eating as assessed by the I-NEQ.Conclusions: VTX can be a valid therapeutic choice for patients with BED with comorbid depression in controlling the depressive symptoms, working memory, and eating behavior. Indeed, by acting on affective symptoms, neurocognitive functioning, and eating behaviors, it confirms the results already obtained with VTX in other disorders, expanding them to BED.

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An open-label trial on the efficacy and tolerability of naltrexone/bupropion SR for treating altered eating behaviours and weight loss in binge eating disorder

Cited by 38 publications

References 64 publications

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Current Intervention Treatments for Food Addiction: A Systematic Review

Naturalistic and Uncontrolled Pilot Study on the Efficacy of Vortioxetine in Binge Eating Disorder With Comorbid Depression

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