Efficacy and Tolerability of Open-Label Topiramate in the Treatment of Sleep-Related Eating Disorder: A Retrospective Case Series

Objective: Determine the efficacy and tolerability of topiramate in the treatment of sleep-related eating disorder (SRED).

Method: This is a retrospective chart review of consecutive patients treated in an open-label trial of topiramate for SRED in a sleep disorders clinic. Patients were diagnosed according to the second edition of the International Classification of Sleep Disorders. Patients with a Clinical Global Impressions of Improvement (CGI-I) rating of “very much” or “much” improved were considered treatment responders.

Results: 30 subjects were prescribed topiramate, of whom 25 had at least 1 postbaseline follow-up appointment. The mean age of these 25 patients was 44 ± 12 years, 76% were female, and the mean age at onset of SRED was 25.2 ± 12.8 years. The mean dose of topiramate was 135 ± 61.6 mg (range, 25-300 mg) over a mean period of 11.6 ± 11.4 months (range, 1-42 months). Over two thirds of the patients (17/25 or 68%) were considered topiramate responders. Twenty-eight percent (7/25) of the patients lost more than 10% of body weight. Adverse events were reported by 84% (21/25) of patients. Nearly half (7/17 or 41%) of the responders discontinued topiramate after a mean of 12.4 months.

Conclusion: In this open-label retrospective trial, topiramate was found to be very effective in reducing nocturnal eating in patients with chronic SRED. The tolerability of topiramate was an issue in some patients. Given the promise of this approach, but the limitations of this study, prospective, double-blind study of topiramate in a larger sample of patients with SRED is warranted.