A Paradigm for Facilitating Pharmacotherapy at a Distance: Sertraline Treatment of the Night Eating Syndrome

Albert J. Stunkard, M.D.; Kelly C. Allison, Ph.D.; Jennifer D. Lundgren, Ph.D.; Nicole S. Martino, B.S.; Moonseong Heo, Ph.D.; Bijan Etemad, M.D.; and John P. O'Reardon, M.D.

Objective: To test a novel method of facilitating pharmacotherapy at a distance and assess the effectiveness of sertraline for the treatment of night eating syndrome (NES).

Method: The effectiveness of the selective serotonin reuptake inhibitor sertraline in the treatment of NES was assessed at a distance. NES is characterized by a delay in the circadian rhythm of food intake, with evening hyperphagia and/or nighttime awakenings and ingestions. Persons who contacted us through our Web site, e-mail, or telephone for help with their NES completed a Night Eating Questionnaire and received a semistructured interview (Night Eating Syndrome History and Inventory) to determine the presence of NES. Fifty such persons received treatment with sertraline from their own physicians, to whom we offered consultation. Participants completed questionnaires every 2 weeks for 8 weeks and received a final telephone interview to assess their progress. Outcomes were compared with those from an earlier face-to-face open-label trial of sertraline. The study was conducted from September 2003 to May 2005.

Results: Both the questionnaires and interviews showed improvements in 5 key aspects of NES: the general Night Eating Symptom Scale, evening hyperphagia, nighttime awakenings, nocturnal ingestions, and the Beck Depression Inventory (all p < .001), and the mean body weight of the 41 overweight and obese subjects, reported by survey, fell 3.0 kg (p = .01). These results are similar to those obtained in an earlier face-to-face trial of sertraline with NES.

Conclusion: The study confirmed the effectiveness of sertraline in the treatment of NES and introduced a paradigm for facilitating pharmacotherapy at a distance.

(J Clin Psychiatry 2006;67:1568-1572)

Received Feb. 17, 2006; accepted March 30, 2006. From the Department of Psychiatry Weight and Eating Disorders Program, University of Pennsylvania School of Medicine, Philadelphia.

This study was supported by grant RO1 DK 56735-04 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases.

Presented at the annual meeting of the North American Association for the Study of Obesity, Nov. 14-18, 2004, Las Vegas, Nev.

Drs. Stunkard and Allison and Ms. Martino have received grant/research support from Pfizer. Drs. Lundgren, Heo, Etemad, and O'Reardon report no additional financial or other relationship relevant to the subject of this article.

Corresponding author and reprints: Albert J. Stunkard, M.D., 3535 Market St., Suite 3025, Philadelphia, PA 19106-3309 (e-mail: stunkard@mail.med.upenn.edu).