Treatment of sleep‐related eating disorder with suvorexant: A case report on the potential benefits of replacing benzodiazepines with orexin receptor antagonists

Abstract

BackgroundNocturnal eating behavior in patients with sleep‐related eating disorder (SRED) is difficult to control and can become chronic, causing weight gain and psychological distress. Here, we report a case of SRED comorbid with major depressive disorder successfully treated by switching from brotizolam to suvorexant, that is, from a benzodiazepine to an orexin receptor antagonist.Case PresentationA 25‐year‐old woman complained of night snacking with partial/complete amnesia and sleepwalking for 1 year. She had a diagnosis of major depressive disorder at age 20 and was on paroxetine and brotizolam for depression and insomnia. At 24 years of age, she experienced her second depressive episode, then her amnestic nocturnal eating became prominent. Even after improvement in depressive symptoms, she experienced uncontrollable nocturnal eating episodes every 2 days, resulting in weight gain of over 10 kg. After a partial amnestic eating episode following an awakening from stage N2 sleep was confirmed through video polysomnography, she was diagnosed with SRED. Considering her strong desire to resolve involuntary eating, we instructed her to discontinue brotizolam and start suvorexant. Subsequently, her nocturnal eating completely disappeared. She experienced rebound insomnia, which improved within 1 month. She was then continued on 10 mg of suvorexant and has not experienced nocturnal eating for 2 years.ConclusionThis case highlights the importance of discontinuing benzodiazepines in the treatment of SRED, but also suggests the potential benefit of orexin receptor antagonists in the treatment of SRED. The efficacy of orexin receptor antagonists in idiopathic SRED should be tested in future studies.

Current evidence and future perspectives in the exploration of sleep-related eating disorder–a systematic literature review

“…She was recommended to discontinue brotizolam (0.25 mg) and was switched on to suvorexant (10 mg), which led to a complete disappearance of SRED. During the 2-year monitoring period, she did not present any new SRED manifestations ( 105 ).…”

“…Replacement of benzodiazepines with other, non-GABA-ergic pharmacological agents, can be beneficial in decreasing and eliminating the occurrence of SRED episodes. For example, suvorexant, a selective dual antagonist of the type 1 and 2 orexin receptors (OX1 and OX2), demonstrated efficacy in a 25-year-old woman diagnosed with depression, who presented episodes of night eating with partial or complete amnesia and sleepwalking for one year ( 105 ). This patient was diagnosed with SRED based on polysomnography, which detected an awakening from the N2 stage sleep from eating.…”

“…Combining pramipexole and clonazepam, carbidopa/l-dopa and codeine, phentermine and topiramate ER, bupropion + l-dopa + trazodone are also explored drug associations for SRED ( 63 , 64 , 95 , 104 ). Agomelatine, pramipexole as monotherapy, suvorexant, and ramelteon benefit from favorable results in case reports or small studies ( 95 , 103 , 105 , 106 ). Psychotherapy, hypnotherapy and CBT included, may be useful for patients with SRED, but there is an obvious need for larger trials to support its efficacy ( 107 – 109 ).…”

Current Evidence and Future Perspective in the Exploration of Sleep-Related Eating Disorder—From Pathogenic Hypotheses to Treatment Approaches

“…The combination of bupropion + l-dopa + trazodone led to good results in patients with SRED [116] Case report (a 25-year-old woman)…”

“…Replacement of benzodiazepines with other, non-GABA-ergic pharmacological agents, can be beneficial in decreasing and eliminating the occurrence of SRED episodes. For example, suvorexant, a selective dual antagonist of the type 1 and 2 orexin receptors (OX1 and OX2), demonstrated efficacy in a 25-year-old woman diagnosed with depression, who presented episodes of night eating with partial or complete amnesia and sleepwalking for one year [116]. This patient was diagnosed with SRED based on polysomnography, which detected an awakening from the N2 stage sleep from eating [116].…”