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Treatment Binge Eating Disorder: 8

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Presentation on theme: "Treatment Binge Eating Disorder: 8"— Presentation transcript:

1 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

2 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

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

4 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

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

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

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

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

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

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

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

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

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

14 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”

15 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

16 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

17 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

18 Questions/Comments?

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