A medication, Vyvanse, approved in the last few weeks for Binge Eating Disorder (BED), ought to be cause for celebration. There just are not many options to treat binging. Yet my first reaction is concern and trepidation.
This medication is a stimulant initially marketed and approved for Attention Deficit Disorder. It is effective and safe for this disorder. A once daily, long-acting alternative to Adderall and Ritalin, Vyvanse was a welcome addition to this class of psychiatric drugs.
One of the most common side effects of stimulants is appetite suppression, the purported effectiveness of Vyvanse in BED. Since children often take stimulants, decreased appetite can lead to weight loss, malnutrition and medical issues. Adults often see this side effect as an added bonus, which only increases the appeal and risk of stimulant usage.
My first concern is that the side effect of appetite suppression is now touted as a potential cure for binge eating, which is patently untrue. These medications can be used to stop binging that is particularly dangerous in the short-term but no more.
Like most side effects, loss of appetite tends to wear off as someone takes Vyvanse regularly. The binging returns soon enough as appetite returns to normal, unless the patient receives alternative treatment. Vyvanse is a bandaid in this instance, not a cure.
My other concern is that Vyvanse is an addictive medication. In other words, people develop a tolerance to the drug so that they will experience withdrawal if it is stopped abruptly. Also the initial effect tends to wear off and necessitates an increased dose for the same effect.
When used for ADD, the doctor can increase the dose until it is effective. Since Vyvanse actually treats the symptoms, the effects will usually be long-lasting. When used for BED, Vyvanse diminishes appetite only as a temporary side effect, so increasing the dose is inevitable when appetite returns to normal.
Continually searching for an effective dose will lead some people to seek higher doses, increasing the chance of taking too much medication. There is no benefit to replacing binging with prescription medication abuse.
The shortage of effective medications for BED is clear to patients and physicians. However, a government agency cannot justify approving an addictive medication with extremely limited use for binge eating as a viable treatment alternative.
It's better to increase awareness and develop more treatment options than propagate false hope.