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Perez-Leighton C, Kerr B, Scherer PE, Baudrand R, Cortés V. The interplay between leptin, glucocorticoids, and GLP1 regulates food intake and feeding behaviour. Biol Rev Camb Philos Soc 2024; 99:653-674. [PMID: 38072002 DOI: 10.1111/brv.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 05/09/2024]
Abstract
Nutritional, endocrine, and neurological signals converge in multiple brain centres to control feeding behaviour and food intake as part of the allostatic regulation of energy balance. Among the several neuroendocrine systems involved, the leptin, glucocorticoid, and glucagon-like peptide 1 (GLP1) systems have been extensively researched. Leptin is at the top hierarchical level since its complete absence is sufficient to trigger severe hyperphagia. Glucocorticoids are key regulators of the energy balance adaptation to stress and their sustained excess leads to excessive adiposity and metabolic perturbations. GLP1 participates in metabolic adaptation to food intake, regulating insulin secretion and satiety by parallel central and peripheral signalling systems. Herein, we review the brain and peripheral targets of these three hormone systems that integrate to regulate food intake, feeding behaviour, and metabolic homeostasis. We examine the functional relationships between leptin, glucocorticoids, and GLP1 at the central and peripheral levels, including the cross-regulation of their circulating levels and their cooperative or antagonistic actions at different brain centres. The pathophysiological roles of these neuroendocrine systems in dysregulated intake are explored in the two extremes of body adiposity - obesity and lipodystrophy - and eating behaviour disorders.
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Affiliation(s)
- Claudio Perez-Leighton
- Departmento de Fisiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins 340, Santiago, 830024, Chile
| | - Bredford Kerr
- Centro de Biología Celular y Biomedicina-CEBICEM, Facultad de Medicina y Ciencia, Universidad San Sebastián, Carmen Sylva 2444, Providencia, Santiago, Chile
| | - Philipp E Scherer
- Touchstone Diabetes Center, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - René Baudrand
- Departmento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins 340, Santiago, 830024, Chile
- Centro Translacional de Endocrinología (CETREN), Facultad de Medicina, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins 340, Santiago, 830024, Chile
| | - Víctor Cortés
- Departmento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins 340, Santiago, 830024, Chile
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Jing E, Gregertsen E, Chen L, Russell J. Knowledge and attitudes towards eating disorders: A survey of psychiatrists and psychiatry trainees in New South Wales. Australas Psychiatry 2024:10398562241249906. [PMID: 38705873 DOI: 10.1177/10398562241249906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To evaluate New South Wales (NSW) psychiatrists' and psychiatry trainees' knowledge and attitudes towards eating disorders (EDs). METHOD A total of 1781 psychiatrists and trainees in NSW were invited to complete an anonymous questionnaire assessing ED confidence, knowledge and attitudes. RESULTS A total of 51 doctors responded to the survey, with 38 completing all items. Significant knowledge gaps were revealed. Respondents expressed a desire for more ED training. CONCLUSION Enhanced ED training in psychiatry education and incorporating the lived experience voice to improve attitudes appear necessary.
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Affiliation(s)
- Elsie Jing
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia; and Marie Bashir Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Eva Gregertsen
- HER Centre Australia and Monash Alfred Psychiatry Research Centre, Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Leo Chen
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia; HER Centre Australia and Monash Alfred Psychiatry Research Centre, Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Janice Russell
- Marie Bashir Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia; InsideOut Institute for Eating Disorders, University of Sydney, Camperdown, NSW, Australia; and Discipline of Psychiatry, University of Sydney, Camperdown, NSW, Australia
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Alur-Gupta S, Dokras A, Cooney LG. Management of polycystic ovary syndrome must include assessment and treatment of mental health symptoms. Fertil Steril 2024; 121:384-399. [PMID: 38244713 DOI: 10.1016/j.fertnstert.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
Polycystic ovary syndrome (PCOS) is an endocrine disorder with reproductive and metabolic manifestations affecting millions of women worldwide. The health risks associated with PCOS, however, go beyond physical health. Over the past decade, data have emerged demonstrating a high risk of concurrent mental health conditions, specifically depression and anxiety, but extending into other aspects of psychological health, including body image distress, eating disorders, and sexual dysfunction. International surveys suggest physician knowledge about the mental health associations with PCOS is poor and that patients are often dissatisfied regarding counseling-related psychological issues. We performed a review of mental health comorbidities in individuals with PCOS, including depression, anxiety, body image distress, eating disorders, psychosexual dysfunction, and decreased quality of life, as well as evaluated the impact of common PCOS treatments on these conditions. Most meta-analyses in reproductive age women demonstrate increased risks of these conditions, although data are more limited in adolescents and older adults. In addition, the impact of PCOS treatments on these conditions as well as data on first-line treatments in the PCOS population is limited. All providers involved in the multidimensional care of individuals with PCOS should be aware of these mental health risks to provide appropriate screening, counseling and referral options. Future studies should be designed to evaluate targeted treatment for individuals with PCOS.
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Affiliation(s)
- Snigdha Alur-Gupta
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York.
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura G Cooney
- Department of Obstetrics and Gynecology, University of Wisconsin, Middleton, Wisconsin
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Aoun L, Almardini S, Saliba F, Haddadin F, Mourad O, Jdaidani J, Morcos Z, Al Saidi I, Bou Sanayeh E, Saliba S, Almardini M, Zaidan J. GLP-1 receptor agonists: A novel pharmacotherapy for binge eating (Binge eating disorder and bulimia nervosa)? A systematic review. J Clin Transl Endocrinol 2024; 35:100333. [PMID: 38449772 PMCID: PMC10915596 DOI: 10.1016/j.jcte.2024.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/04/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
Objective Systematically review evidence on using GLP-1RAs for reducing BEB in BED and BN. Methods Comprehensive literature search (PubMed and Google Scholar) conducted for studies evaluating GLP-1Ras for BEB. Extracted data on study characteristics, efficacy, and safety. Results Studies show that GLP-1RAs (liraglutide and dulaglutide) reduce BE frequency and comorbidities in addition to favorable psychiatric side effect profile compared to current options. However, large-scale, blinded placebo-controlled trials are lacking. Conclusion Early findings suggest promising effects of GLP-1RAs on BEB. However, rigorous clinical trials are needed to firmly establish efficacy, dosing, safety, and comparative effectiveness before considering GLP-1RAs a viable novel approach.
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Affiliation(s)
- Laurence Aoun
- Department of Internal Medicine, Staten Island University Hospital, United States
| | - Shaza Almardini
- Department of Internal Medicine, Staten Island University Hospital, United States
| | - Fares Saliba
- Department of Internal Medicine, Staten Island University Hospital, United States
| | - Fadi Haddadin
- Department of Internal Medicine, Staten Island University Hospital, United States
| | - Omar Mourad
- Department of Internal Medicine, Staten Island University Hospital, United States
| | - Jennifer Jdaidani
- Department of Internal Medicine, Staten Island University Hospital, United States
| | - Zeina Morcos
- Department of Internal Medicine, Staten Island University Hospital, United States
| | - Ibrahim Al Saidi
- Department of Internal Medicine, Staten Island University Hospital, United States
| | - Elie Bou Sanayeh
- Department of Internal Medicine, Staten Island University Hospital, United States
| | - Saliba Saliba
- Department of Physiology, Mcgill University, United States
| | - Michel Almardini
- Faculty of Medicine, American University of Beirut Medical Center, Lebanon
| | - Julie Zaidan
- Endocrinology, Diabetes and Metabolism, Staten Island University Hospital, United States
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5
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Hilbert A. Psychological and Medical Treatments for Binge-Eating Disorder: A Research Update. Physiol Behav 2023:114267. [PMID: 37302642 DOI: 10.1016/j.physbeh.2023.114267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/23/2023] [Accepted: 06/08/2023] [Indexed: 06/13/2023]
Abstract
Binge-eating disorder (BED), characterized by recurrent binge eating in the absence of regular weight-compensatory behaviors, is the most common eating disorder, associated with pronounced mental and physical sequelae. An increasing body of research documents the efficacy of diverse approaches to the treatment of this disorder, summarized in meta-analyses. This research update narratively reviewed randomized-controlled trials (RCTs) on the psychological and medical treatment of BED published between January 2018 to November 2022, identified through a systematic literature search. A total of 16 new RCTs and 3 studies on previous RCTs providing efficacy- and safety-related data were included. Regarding psychotherapy, confirmatory evidence supported the use of integrative-cognitive therapy and, with lower effects, brief emotion regulation skills training for binge eating and associated psychopathology. Behavioral weight loss treatment was revealed to be efficacious for binge eating, weight loss, and psychopathology, but its combination with naltrexone-bupropion did not augment efficacy. New treatment approaches were explored, including e-mental-health and brain-directed treatments, mostly targeting emotion and self-regulation. Additionally, different therapeutic approaches were evaluated in complex stepped-care models. In light of these advances, future research is necessary to further optimize effects of evidence-based treatments for BED, through improvement of existing or development of new treatments, based on mechanistic and/or interventional research, and/or tailoring treatments to personal characteristics in a precision medicine approach.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.
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How gut hormones shape reward: A systematic review of the role of ghrelin and GLP-1 in human fMRI. Physiol Behav 2023; 263:114111. [PMID: 36740132 DOI: 10.1016/j.physbeh.2023.114111] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
The gastrointestinal hormones ghrelin and glucagon-like peptide-1 (GLP-1) have opposite secretion patterns, as well as opposite effects on metabolism and food intake. Beyond their role in energy homeostasis, gastrointestinal hormones have also been suggested to modulate the reward system. However, the potential of ghrelin and GLP-1 to modulate reward responses in humans has not been systematically reviewed before. To evaluate the convergence of published results, we first conduct a multi-level kernel density meta-analysis of studies reporting a positive association of ghrelin (Ncomb = 353, 18 contrasts) and a negative association of GLP-1 (Ncomb = 258, 12 contrasts) and reward responses measured using task functional magnetic resonance imaging (fMRI). Second, we complement the meta-analysis using a systematic literature review, focusing on distinct reward phases and applications in clinical populations that may account for variability across studies. In line with preclinical research, we find that ghrelin increases reward responses across studies in key nodes of the motivational circuit, such as the nucleus accumbens, pallidum, putamen, substantia nigra, ventral tegmental area, and the dorsal mid insula. In contrast, for GLP-1, we did not find sufficient convergence in support of reduced reward responses. Instead, our systematic review identifies potential differences of GLP-1 on anticipatory versus consummatory reward responses. Based on a systematic synthesis of available findings, we conclude that there is considerable support for the neuromodulatory potential of gut-based circulating peptides on reward responses. To unlock their potential for clinical applications, it may be useful for future studies to move beyond anticipated rewards to cover other reward facets.
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Yahya AS, Khawaja S, Williams PS, Naguib M. Binge eating disorder and type 2 diabetes: epidemiology and treatment approaches. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2022. [DOI: 10.1002/pnp.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ahmed Saeed Yahya
- Dr Yahya is a Consultant Psychiatrist at the Maudsley Hospital in South London and the Priory Hospital North London
| | - Shakil Khawaja
- Dr Khawaja is a Consultant Psychiatrist and ECT Clinical Lead at North East London NHS Foundation Trust
| | - Paul Simon Williams
- Dr Williams is a Consultant Forensic Psychiatrist at Barnet, Enfield and Haringey Mental Health NHS Trust
| | - Meena Naguib
- Dr Naguib is a Locum Consultant Psychiatrist at North East London NHS Foundation Trust. Dr Naguib was previously a Consultant in Psychiatric Intensive Care at Barnet, Enfield and Haringey Mental Health NHS Trust
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The Impact of Binge-Like Palatable Food Intake on the Endogenous Glucagon-Like Peptide-1 System in Female Rats. Behav Brain Res 2022; 428:113869. [PMID: 35378108 DOI: 10.1016/j.bbr.2022.113869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/08/2022] [Accepted: 03/29/2022] [Indexed: 11/21/2022]
Abstract
Binge eating involves consumption of large amounts of food and a loss of control over the amount consumed. The incidence of binge eating disorder is higher in females than males, hinting at important sex differences in binge eating behavior, but the neural underpinnings of binge eating still remain unresolved. Recent work in male rats has shown that a history of binge-like palatable food intake suppresses hindbrain expression of preproglucagon (PPG), the precursor for glucagon-like peptide-1 (GLP-1). Given the roles of GLP-1 in reducing feeding and food reward, this could be a mechanism underlying binge-like eating in rodents. However, whether similar effects occur in female rats is unknown. Here, we tested the hypothesis that a history of binge-like palatable food intake in female rats would reduce PPG expression in the nucleus tractus solitarius (NTS), a key central site of GLP-1 production. Female rats given access to vegetable shortening every fourth day (4D) engaged in binge-like feeding, demonstrated by consuming significantly more shortening during the first hour of fat access compared to counterparts with ad libitum (AL) fat access. After several weeks of fat access under these schedules, PPG and GLP-1 receptor (GLP-1R) expression were measured in the NTS and ileum. Surprisingly, and in contrast to previous findings in male rats, there were no significant differences in expression of PPG or GLP-1R in either site in 4D versus AL rats, nor were there effects on plasma GLP-1 levels. These findings highlight key differences in the effects of binge-like intake on the central GLP-1 system in female compared to male rats.
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Harris SR, Carrillo M, Fujioka K. Binge-Eating Disorder and Type 2 Diabetes: A Review. Endocr Pract 2021; 27:158-164. [PMID: 33554873 DOI: 10.1016/j.eprac.2020.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/01/2020] [Accepted: 10/27/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To familiarize health care providers with diagnosis and treatment of binge-eating disorder (BED), a common comorbidity of type 2 diabetes (T2DM). METHODS Literature review of binge eating and T2DM. Key words used in search include BED, T2DM, obesity, and treatment. RESULTS The prevalence of BED in patients with T2DM appears to be much higher than the 2% to 3.5% prevalence seen in the general population. Studies suggest that up to 20% of patients with T2DM have an underlying eating disorder, the most common of which is binge eating. BED is probably underdiagnosed, even though there are multiple simple tools that providers can use to improve screening for the disorder. Though the relationship between BED and hemoglobin A1c control can vary, it appears that binge-eating behaviors can worsen metabolic markers, including glycemic control. Various medications used by patients with diabetes have been associated with new-onset BED, and treatment may be as simple as removing or replacing such agents. Several medications have been found to significantly reduce binge-eating frequency, and potentially, weight. Patients with BED generally benefit from psychotherapy, including cognitive behavioral therapy. CONCLUSION BED, only recently added to the International Classification of Disease-10 diagnostic list, is very common in patients with obesity and T2DM. The diagnosis is important to establish, as treatment or referral for treatment, could potentially improve many of the comorbidities and metrics of T2DM.
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Affiliation(s)
- Samantha R Harris
- Scripps Clinic Medical Group, Division of Diabetes and Endocrinology, La Jolla, California
| | - Maritza Carrillo
- Scripps Clinic Medical Group, Division of Diabetes and Endocrinology, La Jolla, California.
| | - Ken Fujioka
- Scripps Clinic Medical Group, Division of Diabetes and Endocrinology, La Jolla, California
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Levitan MN, Papelbaum M, Carta MG, Appolinario JC, Nardi AE. Binge Eating Disorder: A 5-Year Retrospective Study on Experimental Drugs. J Exp Pharmacol 2021; 13:33-47. [PMID: 33542663 PMCID: PMC7853418 DOI: 10.2147/jep.s255376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/11/2021] [Indexed: 01/18/2023] Open
Abstract
Binge eating disorder (BED) affects a significant rate of the general population causing a negative impact on their quality of life, weight, and self-esteem. Besides psychological treatments that compose the majority of the studies, pharmaceuticals have contributed to improve a host of clinical parameters, thus being an important component of the treatment. We opted to target the latest results by performing a review of the literature on the pharmacology for BED from the last 5 years. To achieve this goal, the terms: "binge eating disorder" and "treatment" were added to the PubMed database and the website clinicaltrials.gov. At least five drugs were either being tested or had already been recognized to improve BED symptoms - although only lisdexamfetamine is currently approved by the FDA to treat this condition. However, due to a better understanding of BED psychopathology in the last decade, it is notorious that improvement of eating-related symptoms is not the only desired target. Due to the significant comorbidity percentage (30%), weight loss is highly pursued, as well as the amelioration of clinical parameters which highlights the importance of having new agents combining both objectives.
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Affiliation(s)
- Michelle N Levitan
- Psychiatry Institute/Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Eating Disorders Department/Sheba Medical Center, Ramat Gan, Israel
| | | | - Mauro G Carta
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università Degli Studi di Cagliari, Cagliari, Italy
| | - Jose C Appolinario
- Psychiatry Institute/Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio E Nardi
- Psychiatry Institute/Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Appolinario JC, Nardi AE, McElroy SL. Investigational drugs for the treatment of binge eating disorder (BED): an update. Expert Opin Investig Drugs 2019; 28:1081-1094. [PMID: 31714807 DOI: 10.1080/13543784.2019.1692813] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction: Binge eating disorder (BED) is the most common eating disorder and is frequently associated with psychiatric and medical comorbidities and functional impairment. Although psychological treatments have been the cornerstones of BED treatment, pharmacologic interventions also play an important part of the multimodal management of this condition.Areas covered: This review examines investigational, approved and other pharmacological agents for the treatment of BED. We searched PubMed and clinicaltrials.gov to identify pharmacological interventions for the management of this condition.Expert opinion: BED pharmacological studies have incorporated new drug targets based on our enhanced understanding of the pathophysiology of BED. Neurobiological dysregulation in the reward center and impulse control circuitry and related disturbances in dopamine neurotransmission are among the neurobiological explanations that have been suggested for BED. These mechanisms serve as a pharmacodynamic foundation for the development of new compounds such as lisdexamfetamine (LDX) and dasotraline. Despite these advances, pharmacological trials in BED have numerous challenges that must be overcome. For most compounds studied, larger and more definitive trials is a high priority.
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Affiliation(s)
- Jose C Appolinario
- Obesity and Eating Disorders Group, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio E Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Susan L McElroy
- Department of Psychiatry and Behavioral Neuroscience, Lindner Center of HOPE, Mason, OH, USA and University of Cincinnati College of Medicine, Cincinnati, OH, USA
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McElroy SL, Guerdjikova AI, Mori N, Romo-Nava F. Progress in Developing Pharmacologic Agents to Treat Bulimia Nervosa. CNS Drugs 2019; 33:31-46. [PMID: 30523523 DOI: 10.1007/s40263-018-0594-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper reviews past and current progress in developing pharmacologic agents for the treatment of individuals with bulimia nervosa (BN). We searched the literature and clinical trial registries for compounds studied in BN, the related condition, binge eating disorder (BED), and preclinical models of binge-eating behavior. Drug classes evaluated included antidepressants, antiepileptic drugs, stimulants and other medications for attention-deficit/hyperactivity disorder, opioid antagonists, and weight loss agents, among others. The only available drugs with established efficacy in BN at this time include antidepressants (especially selective serotonin reuptake inhibitors [SSRIs]) and the antiepileptic topiramate, though the efficacy of these compounds is modest at best. The only medications we found currently receiving empirical study in people with BN were fluoxetine, other serotonergic antidepressants, intranasal naloxone, lisdexamfetamine dimesylate, phentermine-topiramate combination, the antiandrogenic oral contraceptive ethinyl estradiol plus drospirenone, and prazosin. Preclinical models suggest that nociceptin receptor antagonists, the selective serotonin 5-HT2C receptor agonist lorcaserin, monoamine stabilizers, and selective orexin-1 receptor antagonists might be helpful. We found no evidence of a drug developed specifically for the treatment of individuals with BN. Future areas for research in the pharmacotherapy of BN are suggested. Importantly, until drugs are developed specifically for eating disorders, drugs developed for other conditions that are centrally acting and associated with beneficial psychotropic effects and/or reduced appetite or weight loss might be considered for repurposing in BN.
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Affiliation(s)
- Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA. .,University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Anna I Guerdjikova
- Lindner Center of HOPE, Mason, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Francisco Romo-Nava
- Lindner Center of HOPE, Mason, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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