Treatment Binge Eating Disorder: 8

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Presentation transcript:

Treatment Binge Eating Disorder: 8 Treatment Binge Eating Disorder: 8. My Recommendations (Feel Free to Disagree!) (Not All Evidence Based! James E Mitchell, M.D. Feel free to re-title and remove Penn specific stuff

Background: Rx BED Availability Trained Practitioners Learning Proven Psychotherapies (CBT, IPT) Uncommon Difficult Self-help NA Supervised Self-help Uncommon, but could be common Not Difficult Proven Pharmacotherapies Common

Model I Propose: Stepped Care If successful, Medication maintenance + Supervised Self-help If unsuccessful, structured psychotherapy

BED Supervised Self-help +/- LDX*, SSRI*, or SNRI* Not complicated by psychiatric comorbidity or overweight/obesity Supervised Self-help +/- LDX*, SSRI*, or SNRI* *Less side-effects than tricyclics, anti-epileptics

BED Supervised Self-help + SSRI or SNRI Significant depression Patient not overweight/obese Supervised Self-help + SSRI or SNRI

BED Supervised Self-help + SSRI Panic/anxiety disorder Patient not overweight/obese Supervised Self-help + SSRI

BED Supervised Self-help + LDX or Topiramate (+ Phentermine?) Bupropion + Naltrexone) BED Not complicated by Psychiatric comorbidity; Patient significantly overweight/obese

BED Supervised Self-help + SSRI + (after stabilized on antidepressant) add LDX or Topiramate (+Phentermine?) Bupropion + Naltrexone BED Significant depression Patient significantly overweight/obese

BED Supervised Self-help + SSRI + (after stabilized on antidepressant) add Topiramate (+Phentermine?) or Bupropion + Naltrexone BED Panic/Anxiety Disorder Patient significantly overweight/obese

BED CBT or IPT+/- Continue Meds Supervised Self-help + Meds Unsuccessful Patient not significantly overweight/obese CBT or IPT+/- Continue Meds

BED CBT or IPT Weight Loss Meds Supervised Self-help + Meds Unsuccessful Patient significantly overweight/obese CBT or IPT Weight Loss Meds

BED Bariatric Surgery Reassess Obese BMI > 35 + Medical Comorbidities or BMI > 40 Bariatric Surgery (RYGP or Sleeve) Reassess

Case #1 19 y.o. female BMI = 24.5 BED with eating binges every day Not depressed

Case #2 35 y.o. male BMI = 32.0 BED with eating binges 3x/week Insomnia; feelings of sadness, guilt; doesn’t enjoy life Wife states he is “down all the time” No active suicide plan; at times thinks he would be “better off dead”

Case #3 36 y.o. female BMI = 35.5 BED with eating binges every day Not significantly depressed Has Type 2 DM – on Metformin Is hypertensive – on a beta blocker Has been unable to get pregnant despite trying for 3 years

Case #4 17 y.o. female BMI = 22.5 BED with eating binges every day Some self-cutting behavior x 1 year At times abuses alcohol

Case #5 54 y.o. male BMI = 29.5 BED with eating binges 5x/wk Feels consistently depressed; not suicidal Has been seen previously be psychologists x 2; evaluated but never went back

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