Abstract
BackgroundThere is little effective psychopharmacological treatment for individuals with eating disorders who struggle with pervasive, severe affective and behavioral dysregulation.MethodsThis pilot open series evaluated lamotrigine, a mood stabilizer, in the treatment of patients with eating disorders who did not respond adequately to antidepressant medications. Nine women with anorexia nervosa- or bulimia nervosa-spectrum eating disorders in partial hospital or intensive outpatient dialectical behavior therapy (DBT)-based eating disorder treatment took lamotrigine for 147 ± 79 days (mean final dose = 161.1 ± 48.6 mg/day). Participants completed standardized self-report measures of emotion dysregulation and impulsivity after lamotrigine initiation and approximately biweekly thereafter. Mood and eating disorder symptomatology were measured at lamotrigine initiation and at time of final assessment.ResultsLamotrigine and concurrent DBT were associated with large reductions in self-reported affective and behavioral dysregulation (ps < 0.01). Eating disorder and mood symptoms decreased moderately.ConclusionsAlthough our findings are limited by the confounds inherent in an open series, lamotrigine showed initial promise in reducing emotional instability and behavioral impulsivity in severely dysregulated eating-disordered patients. These preliminary results support further investigation of lamotrigine for eating disorders in rigorous controlled trials.
Highlights
There is little effective psychopharmacological treatment for individuals with eating disorders who struggle with pervasive, severe affective and behavioral dysregulation
We previously reported a positive response to lamotrigine in five patients with eating disorders characterized by bulimic symptoms and significant affective and behavioral dysregulation [35]
Participants Participants enrolled in this open trial were female patients in the UCSD Eating Disorders Program deemed appropriate for lamotrigine initiation (n = 14) based on presence of pervasive emotion dysregulation, poor impulse control, and endorsed binge eating and/or purging, as clinically assessed by the program psychiatrists
Summary
There is little effective psychopharmacological treatment for individuals with eating disorders who struggle with pervasive, severe affective and behavioral dysregulation. A growing body of evidence suggests that these dysregulated behaviors may be linked to emotional instability, and that pervasive deficits in cognitive and behavioural self-. The powerful but only temporary relief of dysregulated and impulsive behaviors may reinforce maladaptive cycles [27], and affect dysregulation may contribute to AN-BP, BN, and bulimic symptoms more broadly. These data suggest that directly targeting regulatory deficits may be key to more effective treatment
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