Treatment of Binge-Eating Disorder With Topiramate: A Clinical Case Series
J Clin Psychiatry 2000;61(5):368-372
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Reduced appetite and weight loss
were found in clinical trials of topiramate for epilepsy.
Binge-eating disorder is characterized by recurrent episodes of
binge eating that are not associated with regular use of
inappropriate compensatory behaviors. Overweight and obesity may
be common complications. To explore the effectiveness and
tolerability of topiramate in binge-eating disorder, we describe
the response of 13 consecutive outpatients with binge-eating
disorder to naturalistic, open-label treatment with topiramate.
Method: The response of 13 female
outpatients with binge-eating disorder by DSM-IV criteria to
naturalistic, open-label treatment with topiramate (100-1400
mg/day) was reviewed. Response of binge-eating disorder symptoms
was clinically assessed as none, mild, moderate, marked, or
remission. Weight and side effects were also evaluated.
Results: All 13 patients had comorbid Axis I
psychiatric disorders along with binge-eating disorder and were
receiving psychotropic medications at the time of topiramate
administration. After beginning topiramate treatment, 9 patients
displayed a moderate or better response of binge-eating disorder
symptoms that was maintained for periods ranging from 3 to 30
months (mean ± SD = 18.7 ± 8.0 months). Two other patients
displayed moderate or marked responses that subsequently
diminished. The remaining 2 patients had a mild or no response.
The mean ± SD weight of the 13 patients decreased from 99.3 ±
26.4 kg to 87.5 ± 20.4 kg (z = -2.4, df = 1, p = .02), but only
7 patients lost >= 5 kg of weight. The mean topiramate
treatment dose was 492.3 ± 467.8 mg/day for all 13 patients. The
mean topiramate dose was higher in patients who lost >= 5 kg
than in patients who lost < 5 kg. Also, topiramate dose
correlated significantly with weight loss (p < .01). In
general, topiramate was well tolerated, with neurologic side
effects the most common. Of 3 patients who discontinued
topiramate because of side effects, 2 resumed the drug at a later
date without significant recurrence of these effects.
Conclusion: Topiramate may be an effective
treatment for binge-eating disorder. Controlled studies of
topiramate in binge-eating disorder appear warranted.