February 13, 2015
The Food and Drug Administration (FDA) has just approved Vyvanse (lisdexamfetamine dimesylate) — a drug that’s traditionally used for attention deficit hyperactive disorder (ADHD) — for treating Binge Eating Disorder (BED). The National Eating Disorders Association (NEDA) and the Binge Eating Disorder Association (BEDA) are thrilled with this move. Shire, the pharmaceutical company that makes Vyvanse and is rolling out a marketing campaign for it, has teamed up with these two consumer groups to help alert people to the salience and severity of these conditions and the efficacy of this drug in treating them. But is FDA approval of Vyvanse good news for the food addict — especially the food addict who also struggles with binge eating?
As mentioned above, Vyvanse is a stimulant drug that’s traditionally used for ADHD. Research has shown that it enhances the frontal lobe circuitry in the brain that allows for better attention and impulse control (BED is associated with poor impulse control). The premise with the BED indication is that, if Vyvanse can improve the function of the prefrontal cortex for ADHD, it can similarly improve the impaired impulse control of the binge eater.
The two studies that have researched this hypothesis have shown that Vyvanse can be quite effective. As expected with any stimulant, weight reduction occurred with Vyvanse due to enhanced metabolism (calorie-burning). More important, there was a marked decrease in binge-eating episodes; this was already evident in the first four weeks of the 12-week study. Amphetamines such as Vyvanse not only strengthen impulse control, they also suppress appetite. Which dynamic caused the reduction of binge episodes is not clear in the literature. In any case, for the 2.8% of the population who suffer from BED, this drug may make a difference to their lives.
Shire has reported a 29% increase in sales over the last year. This can only be expected to improve exponentially as more people reach for this drug in order to lose weight and curb their appetite.
With our current inability (and unwillingness) to diagnose food addiction, how many food addicts will now be offered this newly-minted diet pill? Talk about having your cake and eating it too: Food addicts get the promise that they can eat their favorite foods and, if they take this drug, their weight may be maintained and their appetite controlled.
The warning in the ads for Vyvanse are clear: This drug should not be used for those who have an addictive disorder, since there is a high abuse potential in the amphetamine class of drugs. My concern is that if we are missing the diagnosis of food addiction, we may be prescribing a drug that will permit the food addict to continue – and even worsen — his or her addiction under the guise of medical therapy. A food addict in recovery may even pick up one’s trigger foods again. Moreover, if the food addict has a previous history of drug use, such as cocaine, the risk of relapse to previous drug use is high.
We know that at least 5% of the population are food addicts – far more than the estimated people suffering from BED. Among those who are obese, as many as 35% might be food addicts. So it is the obese population that this drug will most likely appeal to – thereby exposing any number of food addicts to its addictive effects. The obese population is a vulnerable group that will be targeted by the educational campaign and will likely be the major source of pharmaceutical industry profits.
How is this drug different from the “speed” stimulant pills (e.g., Dexedrine, caffeine pills) that swamped the diet industry in the 1950s and 1960s? After many years of use, these medications eventually fell out of favor due to the very same side effects that Vyvanse has: slight euphoria, insomnia, agitation, anxiety, even paranoia if used for too long at high doses. There is a high potential for abuse, especially if the drug is snorted or injected; used in these ways, stimulants can be as potent as cocaine. The only difference between yesterday’s diet pills — which eventually became discredited — and the new promise of Vyvanse is intention: This stimulant drug is not being labeled for the use of weight loss, but for impulse control of binge-eating episodes.
Are we destined to repeat the same mistake 50 years later?