Double-Blind, Randomized, Placebo-Controlled Trial of Topiramate Plus Cognitive-Behavior Therapy in Binge-Eating Disorder

Claudino, Angélica Medeiros; Oliveira, Irismar Reis de; Appolinário, José Carlos; Córdas, Taki Athanássios; Duchesne, Mônica; Sichieri, Rosely; Bacaltchuk, Josué

doi:10.4088/jcp.v68n0901

Cited by 141 publications

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“…The results have generally been positive in terms of reduction in binge eating episodes and of weight loss, many times involving weight reductions in excess of what is seen with many pharmacological interventions [29][30][31] . Also, trials using zonisamide have been reported, again with positive results on binge eating frequency and again with substantial weight loss .…”

Section: Anti-epilepticsmentioning

confidence: 99%

Biological Therapies for Eating Disorders

Mitchell¹,

Roerig²,

Steffen³

2013

PsycEXTRA Dataset

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Objective-To provide a comprehensive review of pharmacotherapy and other biological treatments for eating disorders. Method-Literature on this topic was systematically reviewed.Results-The bulimia nervosa literature underscores the utility of antidepressants, particularly SSRIs, in improving the symptoms of the disorder. The literature on binge eating disorder supports efficacy on reduction in binge eating frequency for a variety of compounds. However, such compounds have only modest effects on weight. Certain antiepileptic agents such as topiramate, if tolerated, are probably more useful in terms of weight loss. The number of controlled trials in patients with anorexia nervosa in particular has been quite small, and recent meta-analyses show disappointing results using atypical antipsychotics in anorexia nervosa.Discussion-The pharmacological treatment of eating disorders remains an underdeveloped field although drug therapy clearly plays a role in the treatment of those with bulimia nervosa and binge eating disorder. Other biological therapies have not been adequately studied.Keywords anorexia nervosa; bulimia nervosa; binge eating disorder; pharmacotherapy; drug treatmentThe purpose of this review is to briefly summarize the extant literature on the biological therapies for bulimia nervosa, binge eating disorder and anorexia nervosa. Several other recent reviews have also summarized the literature in this area and may be of interest to readers 1,2 . Pharmacotherapy of Bulimia NervosaSeveral important issues are involved in considering pharmacotherapy for bulimia nervosa (BN). First, as will be seen, the evidence in this area is limited. Many of the reports in the The most frequently studied group of agents are the SSRI antidepressants (fluoxetine -twelve trials, fluvoxamine -three trials, sertraline -one trial and citalopram -one trial) followed by the tricyclic antidepressants (TCAs: desipramine -four trials, imipramine -one trial, and amitriptyline -one trial). Two trials of reversible monoamine oxidase-A inhibitors (MAOI-A) have been reported (brofaromine and moclobemide). Lastly, the serotonin-2 receptor antagonist trazodone (in two trials) has been investigated, as has the serotonin and dopamine reuptake inhibitor bupropion (in one trial). It is important to note that bupropion is contraindicated for the treatment of BN and AN due to its seizure risk. Non-antidepressants have included the serotonin-3 receptor antagonist, ondansetron (one trial), the anticonvulsant topiramate (two trials), the serotonin augmenting agent fenfluramine, which is no longer on the market (one trial), and the androgen antagonist flutamide which was studied in combination with citalopram (see Table 1). Unfortunately, rates of achieving complete remission (abstinence from binge eating and purging) are often not reported. HHS Public Access Controlled TrialsTwenty nine double-blind, placebo controlled trials were reviewed and the type of drug, level of response and abstinence rates are summarized in Table 1. Twelve of the ...

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Section: Anti-epilepticsmentioning

confidence: 99%

Biological Therapies for Eating Disorders

Mitchell¹,

Roerig²,

Steffen³

2013

PsycEXTRA Dataset

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“…Os autores concluíram pela ausência de evidência de eficácia em longo prazo no uso de antidepressivos para o controle do TCAP 54,55 . O topiramato mostra-se eficaz na redução de episódios de compulsão alimentar em diversos estudos [56][57][58] . Zilberstein et al documentaram a eficácia de topiramato em pacientes apresentando compulsão alimentar após colocação de banda gástrica (LAGB) 59 .…”

Section: Compulsão Alimentar E Cirurgia Bariátricaunclassified

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

Gordon

Kaio²,

Sallet³

2011

Rev. psiquiatr. clín.

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ResumoContexto: Nas últimas décadas, diversos estudos longitudinais têm demonstrado a eficácia da cirurgia bariátrica no controle de peso em longo prazo e na redução da mortalidade resultante de complicações clínicas associadas à obesidade. Contudo, os estudos também revelam aumento significativo da mortalidade devida a suicídio e comportamento impulsivo, por razões largamente desconhecidas, o que demonstra a escassez de informações relativas ao manejo clínico de pacientes bariátricos. O presente estudo tem como objetivo sintetizar o estado atual de conhecimentos referentes ao acompanhamento psiquiátrico de pacientes bariátricos. Método: Revisão seletiva da literatura envolvendo artigos indexados no Medline e PubMed até junho de 2010, utilizando-se os termos: "bariatric surgery", "psychiatry", "binge eating", "follow-up" e "outcome". Resultados: Há relativo consenso na literatura de que não haja contraindicação psiquiátrica absoluta para a cirurgia bariátrica, embora a avaliação pré-operatória seja de extrema importância para o diagnóstico e tratamento de eventuais transtornos psiquiátricos, objetivando assegurar aderência ao tratamento multidisciplinar, melhor qualidade de vida e, possivelmente, melhor prognóstico pós-cirúrgico. Entre os transtornos mais prevalentes nessa população, encontra-se o transtorno da compulsão alimentar periódica (TCAP), que está relacionado com menor perda ponderal e pior qualidade de vida, especialmente quando presente no pós-operatório. No acompanhamento pós-operatório, também se deve atentar para o surgimento de sintomas impulsivos, incluindo abuso de álcool e outras substâncias. Conclusão: Diversos estudos indicam elevada prevalência de transtornos mentais e alterações psicopatológicas na população de pacientes bariátricos. Embora a maioria dos pacientes apresente adequado controle ponderal e melhora na qualidade de vida em médio e longo prazo, alguns pacientes desenvolvem alterações relativas ao comportamento alimentar, abuso de álcool e outras substâncias e complicações associadas a comportamento impulsivo, o que remete a hipóteses etiológicas que vão desde modelos neuroquímicos até teorias psicossociais. Por todas essas razões, é de fundamental importância que os profissionais de saúde mental integrem as equipes que avaliam e acompanham os pacientes bariátricos. Gordon PC, et al. / Rev Psiq Clín. 2011;38(4):148-54Palavras-chave: Obesidade, cirurgia bariátrica, psiquiatria, transtorno da compulsão alimentar periódica. AbstractBackground: In recent decades, several longitudinal studies show the efficacy of bariatric surgery on long-term weight control and reductions in mortality due to clinical complications associated with obesity. However, studies also show significantly increased mortality due to suicide and impulsive behavior, for reasons largely unknown, which demonstrates the paucity of information concerning the clinical management of bariatric patients. This study aims to synthesize the current state of knowledge regarding the psychiatric care of bariatric patients. Meth...

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“…It may be that combining medication and one of the effective psychotherapies would be the best approach to the treatment of BED. In one study, the combination of topiramate and CBT led to an abstinence rate of over 80% compared with 61% for placebo (33); however, the critical comparison with medication alone was not made in this study. A recent large-scale multisite study suggests that sibutramine is an effective treatment for both binge eating and weight loss (32).…”

Section: Pharmacological Treatments For Bedmentioning

confidence: 71%

Forty years of progress in the treatment of the eating disorders

Agras

Robinson

2008

Nordic Journal of Psychiatry

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This paper reviews progress in the treatment of the eating disorders between 1968 and 2008. In 1968, no evidence-based treatments were available for any of the eating disorders, and binge eating disorder had not yet been described. In 2008, there are still no evidence-based treatments for anorexia nervosa, although a specific form of family therapy (based on the Maudsley model) appears promising. Both psychotherapeutic and psychopharmacological evidence-based treatments are now available for bulimia nervosa and binge eating disorder. Therapist-assisted selfhelp is a promising approach to treatment because it may reduce the costs of treatment, allow for more adequate dissemination to areas lacking specialty resources and also provide a basis for algorithm-driven approaches to treatment.Anorexia nervosa, Binge eating disorder, Bulimia nervosa, Eating disorders, Evidence-based treatment.W. Stewart Agras, Professor of Psychiatry, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA, E-mail: sagras@stanford.edu. R elatively little was known about the eating disorders in 1968. Although anorexia nervosa (AN) had been described for centuries (1), no evidence-based treatments were available. Bulimia nervosa (BN) was scarcely known and binge eating disorder (BED) and subclinical syndromes namely, eating disorder not otherwise specified (EDNOS) had not been described. Gerald Russell was one of the first to describe BN in 1979 (2). Although some case histories describing aspects of the syndrome were already in the literature, it had taken Russell from 1972 to 1978 to collect 30 cases, something that could be done in a few months today. BED, first called nonpurging BN (3), was not formally described until 1992 (4), hence nothing was known about treatment of this condition in 1968, although cases of binge eating had also been recorded through the centuries. Similarly, the concept of EDNOS was introduced with DSM-IV in 1994 (5).A search of PubMed using the term ''eating disorders'' revealed a rapid increase in publications related to eating disorders over the past 40 years. As can be seen in Fig. 1, the increase began in the early to mid-1980s and has continued exponentially to the present. This increase coincided with a rapid increase in cases of BN presenting to clinics in the early 1980s (6). As a result of the increased interest in eating disorders, the International Journal of Eating Disorders was founded in 1982 and undoubtedly contributed to the increase in the number of eating disorder publications. Treatment for the eating disorders in 1986Table 1 summarizes the state of treatment in 1986 for the two extant eating disorders: AN and BN. As can be seen, there were no evidence-based treatments for either disorder, although a few small-scale treatment trials had been published for both disorders. In the case of AN, most of the trials were small-scale and had shown negative results. For BN, positive results were beginning to emerge in small-scale p...

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Double-Blind, Randomized, Placebo-Controlled Trial of Topiramate Plus Cognitive-Behavior Therapy in Binge-Eating Disorder

Cited by 141 publications

References 0 publications

Biological Therapies for Eating Disorders

Biological Therapies for Eating Disorders

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

Forty years of progress in the treatment of the eating disorders

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