A pilot study used an agent originally designed for patients with epilepsy.
Studies of medications such as SSRIs for individuals with eating disorders have focused on the ED, but many people have co-occurring pervasive severe affective and behavioral problems. A recent trial has offered hope for this subgroup of ED patients.
Some patients with bulimia nervosa (BN) and binge-purge type anorexia nervosa (ANbp) can have many bouts with loss of control eating and compensatory behaviors, such as self-induced vomiting, often with severe medical morbidity. Other comorbid behaviors can include substance abuse, impulsive behaviors such as shoplifting, and self-injury.
Dr. Mary Ellen Trunko and colleagues at the University of California, San Diego, recently reported the results of their pilot study evaluating use of the mood-stabilizing drug lamotrignine (Lamactal®) in a group of patients with ANbp and BN with a range of dysregulated behaviors who had not responded to antidepressants (BPD and Emotion Regulation. 2017; 4:21). The small study group included 9 women with AN or BN-spectrum eating disorders (14 started the trial but 5 did not complete 2 months, for various reasons). All the women were participating in dialectical behavior therapy (DBT) in partial hospital or intensive outpatient treatment settings. Their treatment included 10 hours per day, 6 days per week. As the women improved, they were able to step down to 6 hours of treatment a day and ultimately to 4 hours a day. All participants received a routine lamotrigine titration until a target dose of 100 to 300 mg per day was reached.
Their DBT program included weekly individual sessions, twice-weekly skills training groups using the DBT Skills Manual (Linehan M. DBT Skills Manual, second ed. Guilford Press, New York, 2008), group sessions, and skills coaching via telephone contact or text-messaging outside program hours. The women also underwent emotional and behavior assessments and were studied with a number of questionnaires, including the Eating Disorder Examination Questionnaire (EDEQ). All the DBT therapists met as a team once a week.
An improvement in symptoms was noted
All 9 women who completed the study reported reductions in dysregulated emotions and problems with impulse control. In general BEST and ZAN BPD ratings improved and lamotrignine was said to well-tolerated. One of the women stopped the medication because of a possible rash, a rare but potentially very serious side effect of lamotrigine.
The authors argued for a large-scale rigorous investigation of the drug, with and without DBT or other therapies. This would differ from most med trials in ED in that an inclusive rather than exclusive set of criteria would be used, resulting in a highly comorbid group (of the sort we often see in routine clinical care).