Earlier this year, the US Food and Drug Administration (FDA) approved the use of Vyvanse, a Schedule II controlled substance with a high potential for abuse, for binge-eating disorder in adults.
Binge-eating disorder (BED) is a serious eating disorder in which sufferers frequently consume unusually large amounts of food and feel unable to stop eating. People with this condition eat when they are not hungry and often eat to the point of being uncomfortably full. Feelings of shame and embarrassment by how much they are eating are common, which can result in social isolation. Binge-eating disorder may lead to weight gain and to health problems related to obesity.
Vyvanse is an amphetamine that was once exclusively marketed for the treatment of attention deficit hyperactivity disorder (ADHD). After the FDA gave the green light for Vyvanse’s use in the treatment of BED, Shire Pharmaceuticals, the drug’s manufacturer, hit the ground running with an ad campaign featuring a well-known paid spokesperson: retired tennis star Monica Seles.
Shire also launched a website called BingeEatingDisorder.com as part of the company’s campaign to promote Vyvanse, the only drug that the FDA has approved for BED. Last year, Shire spent more than $2.5 million on raising awareness among doctors about BED. By 2020, the company expects Vyvanse prescribed for BED to bring in $200-300 million per year.
While BED can cause serious health problems, so can Vyvanse. The drug – and it’s manufacturer – have troubled histories that include illegal marketing and child suicides. Shire helped put ADHD on the map, and made billions of dollars from the sale of drugs like Vyvanse and Adderall to treat it. In 2014, Shire settled a whistleblower lawsuit for $56.5 million that alleged the company made false and misleading claims about several of its products, including Vyvanse and Adderall.
As the saying goes, it isn’t a drug if it doesn’t have side effects, and Vyvanse is no exception. The most common side effects users experience include dry mouth, sleeplessness, increased heart rate, jittery feelings, constipation, and anxiety.
The most serious risks include psychiatric problems and heart complications, including sudden death in people who have heart problems or heart defects, and stroke and heart attack in adults. Central nervous system stimulants, like Vyvanse, may cause psychotic or manic symptoms, such as hallucinations, delusional thinking, or mania, even in individuals without a prior history of psychotic illness.
Perhaps in the case of Vyvanse and BED, the treatment is worse than the disease.
Some eating disorder specialists say BED is a complicated disorder that has too many causes and factors to be treated with a single drug:
Melissa Hopper, a psychologist who is an expert in treating BED, said inherent in binge-eating is the sense of being out of control. “Binge-eating disorder is a complex,” she said, and the most effective ways of dealing with it are relearning behaviors, regulating emotions, and identifying triggers — which are done through therapy, not by taking pills. After all, one of the biggest challenges is the fact that humans have to eat – binge-eaters cannot quit cold turkey the way one might try to quit smoking. “You’re constantly faced with something very difficult,” Hopper said.
“I just don’t want there to be the message that there’s a simple pill you can take. These are longstanding behavior patterns that need to be explored and shifted,” Melissa Gerson, clinical director of Columbus Park Collaborate, an outpatient treatment center in New York for people with eating disorders, said. Although the drug sounded promising, she said she would not recommend a drug alone to treat BED. If the problematic behaviors that cause BED are not addressed, “I can’t imagine how you would see any long-term improvements in the symptoms,” she said. Normalizing a patient’s eating habits first is essential, she explained.
Because eating disorders are often linked to anxiety and depression, natural remedies that are used for emotional balance may help too.