Research Bites: Zonisamide Combined with Cognitive Behavioral Therapy in Binge Eating Disorder: A One-year Follow-up Study

| January 21, 2010

by Valdo Ricca, MD; Giovanni Castellini, MD; Carolina Lo Sauro, MD; Carlo M. Rotella, MD; and Carlo Faravelli, MD
Drs. Ricca, Castellini, and Lo Sauro are from the Department of Neurology and Psychiatry, University of Florence, Florence, Italy; Dr. Rotella is from the Department of Pathophysiology, Unit of Endocrinology, University of Florence, Florence, Italy; and Dr. Faravelli is from the Department of Psychology, University of Florence, Florence, Italy.

Excerpted from Psychiatry (Edgemont) 2009;6(11):23–28

Binge eating disorder (BED) is a stable syndrome characterized by recurrent binge eating with a significant sense of loss of control, without compensatory behaviors.[1,2] It represents a clinically significant public health problem,[3] with high prevalence of obesity[4–6] and psychiatric and medical comorbidities.[7,8] Cognitive behavioral therapy (CBT) has been shown to reduce the binge frequency and to improve the main psychopathological features of BED; however, CBT initial results do not seem to be maintained in the long-term.[9,10]

Zonisamide is an antiepileptic drug that can promote weight loss in patients with obesity.[11] The authors of this study evaluated the efficacy and safety of zonisamide as augmentation to individual CBT in the treatment of binge eating disorder patients.

Twenty-four threshold and subthreshold BED patients were enrolled in the CBT treatment group, and 28 patients in the CBT plus zonisamide group. At the beginning (T0), at the end (T1) of treatment, and one year after the end of treatment (T2), body mass index was measured and Eating Disorder Examination-Questionnaire, Binge Eating Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory were administered.

At T1, the CBT plus zonisamide group showed a higher mean reduction of body mass index, Eating Disorder Examination-Questionnaire, Beck Depression Inventory, and Binge Eating Scale scores. At T2, the CBT group regained weight, while the CBT plus zonisamide group reduced their body mass and showed a higher reduction in binge eating frequency and Binge Eating Scale, Eating Disorder Examination-Questionnaire Restraint, and State and Trait Anxiety Inventory scores.

The authors concluded that zonisamide augmentation to individual CBT can improve the treatment of BED patients, reducing body weight and the number of binge eating episodes. These results are maintained one year after the end of treatment.
The interpretation of these results is difficult, but it can be hypothesized that zonisamide is able to act on the central hunger and satiety mechanisms, reducing the urge to binge, and therefore promoting improvement in the typical concerns that characterize the psychopathological nucleus of BED syndrome. It can be hypothesized that these effects could in turn contribute to the amelioration of the anxious and depressive syndromes in the BED patients.

Limitations: This study is an open study, and the absence of a placebo in the CBT group reduces the power of the results. Larger, controlled trials are warranted.

For the complete study, please visit www.psychiatrymmc.com and enter zonasimide in the “search” field.

References
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition. Washington, DC: American Psychiatric Press, Inc., 1994.
2. Pope HG Jr, Lalonde JK, Pindyck LJ, et al. Binge eating disorder: a stable syndrome. Am J Psychiatry. 2006;163:2181–2183.
3. National Task Force on the Prevention and Treatment of Obesity. Dieting and the development of eating disorders in overweight and obese adults. Arch Intern Med. 2000;160:2581–2589.
4. Ricca V, Mannucci E, Moretti S, et al. Screening for binge eating disorder in obese outpatients. Comp Psychiatry. 2000;41:111–115.
5. de Zwaan M. Binge eating disorder and obesity. Int J Obes. 2001;25(Suppl. 1):S51–S55.
6. Grucza RA, Przybeck TR, Cloninger CR. Prevalence and correlates of binge eating disorder in a community sample. Compr Psychiatry. 2007;48:124–131.
7. Grilo CM, Masheb RM, Wilson GT. Efficacy of cognitive behavioral therapy and fluoxetine for the treatment of binge eating disorder: a randomized double-blind placebo-controlled comparison. Biol Psychiatry. 2005;57:301–309.
8. Striegel-Moore RH, Wilson GT, Wilfley DE, et al. Binge eating in an obese community sample. Int J Eat Disord. 1998;23:27–37.
9. Brownley KA, Berkman ND, Sedway JA, et al. Binge eating disorder treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007;40:337–348.
10. Yager J. Binge eating disorder: the search for better treatments. Am J Psychiatry. 2008;165:4–6.
11. Gadde KM, Franciscy DM, Wagner HR, Krishnan KR. Zonisamide for weight loss in obese adults: a randomized controlled trial.

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