The Night Eating Syndrome: An Update

The night eating syndrome, first described in 1955, is an eating disorder characterized by a delay in the circadian pattern of eating that disrupts normal sleep. Those with the syndrome eat a large proportion of their daily calories after their evening meal and wake up at night to eat. In the morning most have little or no appetite.

Most reports of the night eating syndrome have involved obese persons. However, a recent study reported that many night eaters were of normal weight (Int J Eat Disord 2004;35:217). This fortuitous discovery came from the use of a night eating syndrome website and questionnaires that showed remarkably similar responses from 40 obese persons and 40 of normal weight.

Treatment with SSRIs

Dr. Albert J. Stunkard and colleagues at the Weight and Eating Disorders program at the University of Pennsylvania School of Medicine recently reported that such patients might benefit from treatment with selective serotonin reuptake inhibitors (SSRIs) (Appetite 2005; 45:182). In his clinic, 23 night eaters were asked about any medications they felt had helped their condition—a total of 83 products were mentioned. These included antidepressants, hypnotics, and herbal preparations. Only one agent showed consistent effectiveness—phenfluramine and phentermine (‘fen-phen’).

Seventeen of the 23 night eaters then underwent an open-label trial over 12 weeks with the SSRI sertraline. Twelve were women with a mean age of 46 years and a mean body mass index (BMI) of 39.3) and 5 were men with a mean age of 50.0 and a mean BMI of 31. All the men and women in the trial showed frequent nocturnal arousals with food intake, evening hyperphagia and morning anorexia.

The subjects received 50 mg/day of sertraline for the first 2 weeks, after which the dosage was increased, as tolerated, to a maximum of 200 mg/day. The average daily dose at the end of the 12-week trial was 188 mg. The participants were seen every other week for a 30-minute follow-up visit.

Nocturnal awakenings, caloric intake, and ingestions were reduced

Twelve of the 17 men and women completed the study. By week 12, four primary outcome measures showed highly significant improvement. The number of awakenings per night fell from 2.0 per night to 0.8; nocturnal ingestions fell from 1.5 per night to 0.5 per night, and caloric intake after supper fell from 51.6% to 25.7%. The Clinical Global Impression of Improvement fell from 4% to 2.6%.

Three subjects discontinued treatment because of excess sleepiness or increased anxiety, and one dropped out because of hypomania. One was lost to follow-up. The three who developed sleepiness or anxiety had their dosage reduced after the side affects appeared and discontinued it at a dosage of 37.5 mg/day, suggesting a special sensitivity to sertraline.

Five subjects fully remitted and three responded to the medication. Were the beneficial effects derived solely from the drug’s antidepressant action? According to the authors, the correlation between the improvement in measures of night eating correlated nonsignificantly with the improvement of depression on the Beck Depression Inventory.

Thus, the authors feel that the night-eating syndrome may be helped by pharmacotherapy, particularly with serotonin-enhancing medications. A double-blind trial of sertraline is currently underway.