Efficacy and Tolerability of Open-Label Topiramate in the Treatment of Sleep-Related Eating Disorder

Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 12/2006; 67(11):1729-34. DOI: 10.4088/JCP.v67n1109
Source: PubMed


Determine the efficacy and tolerability of topiramate in the treatment of sleep-related eating disorder (SRED).
This is a retrospective chart review of consecutive patients treated in an open-label trial of topiramate for SRED in a sleep disorders clinic. Patients were diagnosed according to the second edition of the International Classification of Sleep Disorders. Patients with a Clinical Global Impressions of Improvement (CGI-I) rating of "very much" or "much" improved were considered treatment responders.
30 subjects were prescribed topiramate, of whom 25 had at least 1 postbaseline follow-up appointment. The mean age of these 25 patients was 44 +/- 12 years, 76% were female, and the mean age at onset of SRED was 25.2 +/- 12.8 years. The mean dose of topiramate was 135 +/- 61.6 mg (range, 25-300 mg) over a mean period of 11.6 +/- 11.4 months (range, 1-42 months). Over two thirds of the patients (17/25 or 68%) were considered topiramate responders. Twenty-eight percent (7/25) of the patients lost more than 10% of body weight. Adverse events were reported by 84% (21/25) of patients. Nearly half (7/17 or 41%) of the responders discontinued topiramate after a mean of 12.4 months.
In this open-label retrospective trial, topiramate was found to be very effective in reducing nocturnal eating in patients with chronic SRED. The tolerability of topiramate was an issue in some patients. Given the promise of this approach, but the limitations of this study, prospective, double-blind study of topiramate in a larger sample of patients with SRED is warranted.

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    • "1. anticonvulsants such as topiramate [16]. "
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    ABSTRACT: The NES is an emerging disease in eating behavior that combines eating disorders, sleep, mood and stress. In recent years, the NES is becoming more interested in close association with obesity and depression. In the present study we have followed for 12 weeks 5 patients (2 males and 3 females) with NES and comorbid depression treated with agomelatine (25 mg / day for the first two weeks, then 50 mg / day), an antidepressant similar of melatonin. At the end of the three months of treatment, it was found an improvement in symptoms characteristic of the NES, as assessed by a reduction an average of the NEQ (from 31 to 22.8), improved mood, mean values reduced by 23, 2 to 13.2 on the HAM-D, weight reduction, an average of 3.6 kg reduction in average weekly awakenings from 12 to 6.4 and the time of snoring and motion detected polysomnography. The serum chemistry values remained stable and there were no reported adverse events. The present study showed that the treatment with agomelatine has improved the symptoms of NES and mood, decrease of body weight, reduce, albeit not in an optimal manner, the number of awakenings per night with a reduction of movement time and snoring . Of course, these preliminary data need to be confirmed by controlled trials on a larger sample.
    The Open Neurology Journal 07/2013; 7(1):32-7. DOI:10.2174/1874205X20130626001
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    • "anticonvulsants such as topiramate [16], "
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    ABSTRACT: Night eating syndrome (NES) is a nosographic entity included among the forms not otherwise specified (EDNOS) in eating disorders (ED) of the DSM IV. It is characterized by a reduced food intake during the day, evening hyperphagia, and nocturnal awakenings associated with conscious episodes of compulsive ingestion of food. Frequently, NES patients show significant psychopathology comorbidity with affective disorders. This paper describes a case report of an NES patient treated with agomelatine, an antidepressant analogue of melatonin, which acts by improving not only the mood but also by regulating sleep cycles and appetite. After three months of observation, the use of Agomelatine not only improved the mood of our NES patient (assessed in the HAM-D scores) but it was also able to reduce the night eating questionnaire, by both reducing the number of nocturnal awakenings with food intake, the time of snoring, the minutes of movement during night sleep (assessed at polysomnography), and the weight (-5.5 kg) and optimizing blood glucose and lipid profile. In our clinical case report, agomelatine was able both to reduce the NES symptoms and to significantly improve the mood of our NES patient without adverse side effects during the duration of treatment. Therefore, our case report supports the rationale for further studies on the use of Agomelatine in the NES treatment.
    Case Reports in Medicine 05/2013; 2013:867650. DOI:10.1155/2013/867650
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    • "The activation of reward circuits during sleep would be primarily related to memory consolidation, learning enhancement, performance improvement, as well as to the generation of dreams and their motivated content (Perogamvros and Schwartz, 2012). Exploratory and instinctual behaviors in humans are also observed in parasomnias: locomotion in sleepwalking, aggression in REM sleep behavior disorder, sexual behaviors in confusional arousals, and feeding, chewing, or swallowing in the SRED (Vetrugno et al., 2006; Winkelman, 2006). These complex motor behaviors are most often characterized by negative affect (screaming, crying; Oudiette et al., 2009), high motivational value (chewing, swallowing, and sexual behaviors), or even compulsive character (SRED, leg motor activity, sleep-related smoking disorder, and trichotillomania; Murphy et al., 2006; Provini et al., 2008, 2009). "
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    ABSTRACT: In this paper, we present two carefully documented cases of patients with sleep-related eating disorder (SRED), a parasomnia which is characterized by involuntary compulsive eating during the night and whose pathophysiology is not known. Using video-polysomnography, a dream diary and psychometric examination, we found that both patients present elevated novelty seeking and increased reward sensitivity. In light of new evidence on the mesolimbic dopaminergic implication in compulsive eating disorders, our findings suggest a role of an active reward system during sleep in the manifestation of SRED.
    Frontiers in Neurology 11/2012; 3:168. DOI:10.3389/fneur.2012.00168
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