d-Fenfluramine is an appetite suppressant recently approved by the FDA for weight loss. However, some clinicians use this medication for binge eating disorder and bulimia nervosa in the absence of controlled efficacy data. This controlled study examined the efficacy of d-fenfluramine in 28 obese patients with binge eating disorder.
Initially, 50 patients with binge eating disorder received placebo for four weeks. After the placebo period, the 28 placebo nonresponders were randomized to receive eight weeks of either d-fenfluramine (weeks 1 and 8, 15 mg/day; weeks 2-7, 30 mg/day) or placebo. The mean number of binges per week decreased significantly in the treated group (from 2.2 to 0.6) but remained the same in the placebo group (2.3). Eight of ten drug-treated patients with adequate plasma levels stopped binge eating completely. However, the frequency of binge eating in the treated group returned to pretreatment levels four months after treatment was discontinued. Neither group lost weight during the trial.
Comment: The efficacy of d-fenfluramine to stop binge eating disorders in placebo nonresponders is encouraging. The fact that binge eating returned to previous levels after the medication was stopped is consistent with studies showing that d-fenfluramine works only while it is taken. Since patients were told not to diet or expect weight loss during the study, the absence of weight loss in the treated group suggests that patients' expectations play a prominent role in d-fenfluramine's efficacy as a weight-loss drug.
Published in Journal Watch Psychiatry January 1, 1997
Stunkard A et al. d-Fenfluramine treatment of binge eating disorder. Am J Psychiatry 1996 Nov 153 1455-1459.
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