Topiramate Seems to Improve Sleep-Related Eating Disorder


SALT LAKE CITY – Patients with sleep-related eating disorder may benefit from topiramate treatment, a small study suggests.

Of 17 patients with chronic sleep-related eating disorder (SRED) who were treated with the anticonvulsant, 4 discontinued treatment due to lack of efficacy and 2 others stopped taking the drug because of side effects, including pruritus and weight gain.

The remaining 11 patients remained on therapy for a mean follow-up of 2 years, with all 11 achieving full or substantial control of SRED episodes. Ten of these 11 patients lost a substantial amount of weight (mean of 9.4 kg), Dr. Carlos H. Schenck reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Topiramate has been shown in previous studies to promote weight loss and control binge eating, and at least two case reports have suggested that it is helpful for controlling SRED. In the current study, the 17 patients presented with weight gain and nonrestorative sleep as a result of SRED; 9 had failed prior therapies for the condition; and the other 8 received topiramate as first-line therapy, noted Dr. Schenck of the Minnesota Regional Sleep Disorders Center and the University of Minnesota, both in Minneapolis.

Patients were initially treated with 25 mg topiramate at bedtime, with weekly increases of 25 mg as needed and as tolerated. The maximum dosage was 400 mg, with a mean dosage of 104.5 mg in the 11 patients who remained on therapy. Those patients had a mean age of 45 years, and nine were women. The duration of SRED ranged from 3 to 45 years, and 10 patients experienced nightly SRED episodes.

In 5 of the 11 patients, SRED was idiopathic, and in 6, the SRED was presumed symptomatic; eight other sleep disorders were present in these patients. These disorders included restless legs syndrome/periodic limb movement disorder in five patients and sleepwalking, narcolepsy, and primary insomnia in one patient each.

In addition, five patients had one or more Axis I psychiatric disorders, including four patients with a mood disorder, one with chemical dependency in remission, two with anxiety disorder, and one with a paranoid disorder.

Eight patients were using other medications at the time topiramate was initiated; these included benzodiazepines/agonists (five patients), dopaminergics (three patients), trazodone (three patients), antipsychotics (two patients), and daytime psychotropics (four patients).

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