Introduction

Binge Eating Disorder (BED) is the most common eating disorder, yet it’s often under-recognized and undertreated. Characterized by recurrent episodes of eating large quantities of food with a feeling of loss of control, BED can severely impact emotional, physical, and social well-being.

In 2015, Lisdexamfetamine dimesylate (Vyvanse) became the first and only medication approved by the FDA specifically for the treatment of moderate to severe BED. This marks a significant shift in how clinicians can approach pharmacological intervention.

But when should lisdexamfetamine be considered in BED treatment? Let’s explore the evidence.

FDA Approval and Mechanism

Lisdexamfetamine is a prodrug of dextroamphetamine, commonly used to treat ADHD. Its role in BED stems from its effect on dopamine and norepinephrine pathways, which are involved in both impulse regulation and reward sensitivity — key neurobiological mechanisms implicated in binge eating.

In clinical trials, patients on lisdexamfetamine showed:

• Reduced binge days per week

• Greater control over eating behavior

• Improved functioning and reduced distress

Dosages approved for BED range between 30 mg to 70 mg daily, titrated based on response and tolerability.

When to Consider Lisdexamfetamine for BED

Lisdexamfetamine should be considered in the following scenarios:

1. Moderate to Severe BED

When binge episodes occur ≥1 time per week for at least 3 months and cause significant distress or impairment, lisdexamfetamine becomes a viable treatment option.

2. Failure of Non-Pharmacological Therapies

While Cognitive Behavioral Therapy (CBT) remains first-line, not all patients respond adequately. If there’s poor response to psychotherapy, or if access is limited, medication becomes crucial.

3. Coexisting ADHD

There is a high comorbidity between BED and ADHD—studies estimate up to 30% overlap. Lisdexamfetamine can address both conditions simultaneously, improving attention, reducing impulsivity, and controlling binge behaviors.

4. Need for Rapid Symptom Control

For patients struggling with emotional distress, weight gain, or occupational impairment due to frequent binge episodes, lisdexamfetamine offers faster symptom relief than traditional SSRIs or topiramate.

What Does the Research Say?

A pivotal 2015 study by McElroy et al. (JAMA Psychiatry) found that patients on lisdexamfetamine had significantly fewer binge days compared to placebo, with 50–70 mg showing the best efficacy.

A relapse prevention trial also showed that:

• Patients stabilized on lisdexamfetamine had reduced relapse rates over time.

• Continuation of treatment was superior to placebo in maintaining remission.

These findings highlight the importance of treatment duration and monitoring for relapse—especially in those with chronic patterns of binge eating.

Comparing with Other Medications

Lisdexamfetamine stands out for its specific regulatory approval and strong clinical evidence, especially in patients with comorbid impulsivity or ADHD.

Clinical Considerations and Cautions

• Start at 30 mg, increase weekly by 20 mg as needed.

• Monitor for sleep issues, elevated BP/HR, mood changes.

• Avoid in patients with substance use history, cardiovascular disease, or severe anxiety.

• Educate patients on non-appetite-related benefits to avoid misuse.

Conclusion

Lisdexamfetamine offers a powerful treatment avenue for moderate to severe Binge Eating Disorder, particularly when:

• Psychotherapy is insufficient or unavailable,

• Rapid symptom relief is needed,

• ADHD or impulsivity traits are co-occurring.

Its evidence-based approval and dual benefits make it a unique tool in modern psychiatric practice. However, careful assessment and follow-up are essential to ensure both efficacy and safety.

Have questions or want to know if lisdexamfetamine is right for you or your patients?

Dr. Srinivas Rajkumar T
Consultant Psychiatrist
Apollo Clinic, Velachery & Tambaram, Chennai
📧 srinivasaiims@gmail.com | ☎️ 8595155808