Lamotrigine use in patients with binge eating and purging, significant affect dysregulation, and poor impulse control

Trunko, Mary Ellen; Schwartz, Terry Ann; Marzola, Enrica; Klein, Angela S.; Kaye, Walter H.

doi:10.1002/eat.22234

Cited by 15 publications

(13 citation statements)

References 20 publications

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“…Our results are consistent with prior reports of lamotrigine treatment benefit for some patients with BN- and AN-BP-spectrum disorders [35, 52, 53] and for some patients with binge-eating behaviors [54]. As noted previously, lamotrigine is utilized in other conditions characterized by dysregulated mood and poor impulse control, including bipolar disorder and BPD.…”

Section: Discussionsupporting

confidence: 92%

“…This led us to speculate that medications with mood-stabilizing properties [32–34] may be a better alternative for some. We previously reported a positive response to lamotrigine in five patients with eating disorders characterized by bulimic symptoms and significant affective and behavioral dysregulation [35]. Though encouraging, these case reports were based on personal observation.…”

Section: Introductionmentioning

confidence: 99%

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A pilot open series of lamotrigine in DBT-treated eating disorders characterized by significant affective dysregulation and poor impulse control

Trunko

Schwartz

Berner

et al. 2017

bord personal disord emot dysregul

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BackgroundThere is little effective psychopharmacological treatment for individuals with eating disorders who struggle with pervasive, severe affective and behavioral dysregulation.MethodsThis pilot open series evaluated lamotrigine, a mood stabilizer, in the treatment of patients with eating disorders who did not respond adequately to antidepressant medications. Nine women with anorexia nervosa- or bulimia nervosa-spectrum eating disorders in partial hospital or intensive outpatient dialectical behavior therapy (DBT)-based eating disorder treatment took lamotrigine for 147 ± 79 days (mean final dose = 161.1 ± 48.6 mg/day). Participants completed standardized self-report measures of emotion dysregulation and impulsivity after lamotrigine initiation and approximately biweekly thereafter. Mood and eating disorder symptomatology were measured at lamotrigine initiation and at time of final assessment.ResultsLamotrigine and concurrent DBT were associated with large reductions in self-reported affective and behavioral dysregulation (ps < 0.01). Eating disorder and mood symptoms decreased moderately.ConclusionsAlthough our findings are limited by the confounds inherent in an open series, lamotrigine showed initial promise in reducing emotional instability and behavioral impulsivity in severely dysregulated eating-disordered patients. These preliminary results support further investigation of lamotrigine for eating disorders in rigorous controlled trials.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

A pilot open series of lamotrigine in DBT-treated eating disorders characterized by significant affective dysregulation and poor impulse control

Trunko

Schwartz

Berner

et al. 2017

bord personal disord emot dysregul

Self Cite

View full text Add to dashboard Cite

show abstract

“…With regard to the treatment of BN, the present findings suggest that NA and PA instability could represent useful targets for novel interventions or treatment adjuncts, particularly via an increased focus on maintaining a steady affective state and reducing the likelihood of extreme increases in NA (e.g., by encouraging use of therapeutic skills earlier in the emotion generation process or, in severe cases, adding a mood stabilizing medication; Trunko et al, 2014). If post-behavior affective instability drives the recurrence of binge eating and purging, a specific focus on implementing skills during the post-behavior time period could be particularly helpful.…”

Section: Discussionmentioning

confidence: 91%

Temporal associations between affective instability and dysregulated eating behavior in bulimia nervosa

Berner

Crosby

Cao

et al. 2017

Journal of Psychiatric Research

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Prior research suggests that the construct of emotional instability may be salient to bulimia nervosa (BN), but no study to date has used ecological momentary assessment (EMA) to examine its temporal association with binge eating and purging. In the current study, 133 women with DSM-IV BN used portable digital devices to provide multiple daily negative affect (NA) and positive affect (PA) ratings and record eating disorder behaviors over 2 weeks. Two state-of-the art indices quantified affective instability: probability of acute change (PAC), which represents the likelihood of extreme affective increases, and mean squared successive difference (MSSD), which represents average change over successive recordings. For extreme affective change, results revealed that on bulimic behavior days, extreme NA increases were less likely after bulimic behaviors than before them, and extreme increases in PA were more likely after bulimic behaviors than during the same time period on non-bulimic behavior days. However, average NA instability (i.e., MSSD) was (a) greater on bulimic behavior days than non-bulimic behavior days, (b) greater after bulimic behaviors than during the same time period on non-bulimic behavior days, and (c) greater after bulimic behaviors than before them. Results lend support to the notion that bulimic behaviors are negatively reinforcing (i.e., via post-behavior acute affective changes), but also indicate that these behaviors may exacerbate overall affective dysregulation. These findings may improve understanding of BN maintenance and inform the development of novel interventions or refinement of existing treatments.

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“… 100 , 101 , 102 , 103 , 104 Finally, lamotrigine has been shown to significantly improve eating disorder and mood symptoms in individuals with binge-eating and purging behaviors. 105 …”

Section: Discussionmentioning

confidence: 99%

Investigation of common, low-frequency and rare genome-wide variation in anorexia nervosa

et al. 2017

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Anorexia nervosa (AN) is a complex neuropsychiatric disorder presenting with dangerously low body weight, and a deep and persistent fear of gaining weight. To date, only one genome-wide significant locus associated with AN has been identified(1). We performed an exome-chip based GWAS in 2,158 cases from nine populations of European origin and 15,485 ancestrally matched controls. Unlike previous studies, this GWAS also probed association in low-frequency and rare variants. Sixteen independent variants were taken forward for in silico and de novo replication (11 common, 5 rare). No findings reached genome-wide significance. Two notable common variants were identified; rs10791286, an intronic variant in OPCML (p=9.89x10-6), and rs7700147, an intergenic variant (p=2.93x10-5). No low-frequency variant associations were identified at genome-wide significance, although the study was well-powered to detect low frequency variants with large effect sizes, suggesting that there may be no AN loci in this genomic search space with large effect sizes.

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Lamotrigine use in patients with binge eating and purging, significant affect dysregulation, and poor impulse control

Abstract: These findings raise the possibility that lamotrigine, either as monotherapy or as an augmenting agent to antidepressants, may be useful in patients who binge eat and purge, and have significant affect dysregulation with poor impulse control.

Cited by 15 publications

References 20 publications

A pilot open series of lamotrigine in DBT-treated eating disorders characterized by significant affective dysregulation and poor impulse control

A pilot open series of lamotrigine in DBT-treated eating disorders characterized by significant affective dysregulation and poor impulse control

Temporal associations between affective instability and dysregulated eating behavior in bulimia nervosa

Investigation of common, low-frequency and rare genome-wide variation in anorexia nervosa

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