Efficacy and tolerability of open-label topiramate in the treatment of sleep-related eating disorder: a retrospective case series.
ABSTRACT 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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ABSTRACT: Criteria for inclusion of diagnoses of Axis I disorders in the forthcoming Diagnostic and Statistical Manual (DSM-V) of the American Psychiatric Association are being considered. The 5 criteria that were proposed by Blashfield et al as necessary for inclusion in DSM-IV are reviewed and are met by the night eating syndrome (NES). Seventy-seven publications in refereed journals in the last decade indicate growing recognition of NES. Two core diagnostic criteria have been established: evening hyperphagia (consumption of at least 25% of daily food intake after the evening meal) and/or the presence of nocturnal awakenings with ingestions. These criteria have been validated in studies that used self-reports, structured interviews, and symptom scales. Night eating syndrome can be distinguished from binge eating disorder and sleep-related eating disorder. Four additional features attest to the usefulness of the diagnosis of NES: (1) its prevalence, (2) its association with obesity, (3) its extensive comorbidity, and (4) its biological aspects. In conclusion, research on NES supports the validity of the diagnosis and its inclusion in DSM-V.Comprehensive psychiatry 09/2009; 50(5):391-9. DOI:10.1016/j.comppsych.2008.09.013 · 2.26 Impact Factor