Evidence-Based Reviews

Curbing nocturnal binges in sleep-related eating disorder

Current Psychiatry. 2007 July;6(7):19-24

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CASE CONTINUED: Adding medication

After diagnosing SRED, Ms. G’s psychiatrist initiates the anticonvulsant topiramate, 25 mg at bedtime. After the dose is gradually increased in 25-mg increments to 100 mg at bedtime, Ms. G achieves full control of recurrent nocturnal eating. She loses 40 pounds within the next 6 months.

Pharmacotherapy

SRED is treatable and a reversible cause of obesity. The choice of medication depends on:

which form of SRED the patient exhibits (drug-induced or idiopathic)
whether the patient has treatable comorbid conditions.

Temazepam. Switch patients whose SRED is triggered by zolpidem or another hypnotic to a different agent. We have had excellent success with temazepam, 15 to 30 mg at bedtime.

Clinical Point

Self-induced emesis or other purging behavior usually is not seen in SRED

Topiramate. For idiopathic SRED or the sleepwalking variant of SRED, trials from 2 academic institutions suggest that off-label use of topiramate, 25 to 150 mg at bedtime, may be the treatment of choice.^16-18

Start topiramate at 25 mg, and increase in 25-mg increments every 5 to 7 days until the night eating episodes are eliminated. Paresthesias, visual symptoms, and (rarely) renal calculus are reported side effects.

Other medications. Other agents that have shown at least some benefit in patients with SRED include dopaminergic agonists, opiates, and clonazepam.¹⁴ Patients with SRED and a history of chemical dependency may respond to combined levodopa, trazodone, and bupropion (dopaminergic/noradrenergic antidepressant) therapy at bedtime.¹⁹ Also focus treatment on any coexisting sleep disorder, such as RLS or OSA.

Related resources

American Obesity Association. www.obesity.org.
American Insomnia Association. www.americaninsomniaassociation.org.
Schenck CH. Paradox lost: midnight in the battleground of sleep and dreams. Minneapolis, MN: Extreme-Nights, LLC; 2006.

Drug brand names

Bupropion • Wellbutrin
Clonazepam • Klonopin
Levodopa/carbidopa • Sinemet
Lithium • Eskalith, Lithobid
Olanzapine • Zyprexa
Risperidone • Risperdal
Temazepam • Restoril
Topiramate • Topamax
Trazodone • Desyrel
Triazolam • Halcion
Zolpidem • Ambien

Disclosures

Drs. Howell and Schenck report no financial relationships with any companies whose products are mentioned in this article or with manufacturers of competing products.

Dr. Crow has received grants or research support from Bristol-Myers Squibb and Pfizer Inc. and served as a consultant to Eli Lilly and Company.