Vyvanse: An Inappropriate Medication in the Treatment of BED

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In a previous blog, I wrote about Vyvanse, a type of amphetamine, that recently received swift approval from the FDA to treat binge eating disorder (BED).

No doubt, Vyvanse helps people who are accurately diagnosed with attention deficit hyperactivity disorder (ADHD). However, there are other treatments that help with ADHD as well, many of which you hear nothing about because they lack a pharmaceutical company-backed marketing campaign. (CBT is one example).

There are also non-stimulant medications for ADHD, which are utilized when there is a good clinical reason NOT to use a potentially addictive and appetite suppressing medication, such as if someone has a heart rhythm disorder, a substance use disorder or eating disorder. Last time I checked, BED IS an eating disorder.

Most clinically sound treatment approaches for BED, and any eating disorder, have at least some focus on helping the person accept their body’s natural size and shape (rather than struggle endlessly to achieve a societally sanctioned and sick thin ideal).

Another focus of clinically sound eating disorder treatment is helping patients learn to recognize and honor their natural appetites, hunger and satiety cues. Stimulants suppress this aspect of a person’s being. Therefore, such learning is limited for those who take medications like Vyvanse.

With an eating disorder, a person might binge, restrict, or practice other unhealthy food-related behaviors. We know this is not “the” problem, rather it is an overt symptom of the core emotional, spiritual, and physical pain the person is experiencing. Effective treatment necessitates getting to that core and discovering what is actually driving the disorder. Once the origin of the pain is unearthed, it can be addressed in a therapeutic environment.

We want the person to see that her method of hurting and controlling her body was born out of necessity and became an unhealthy strategy to cope with loss, anger, or trauma that once overwhelmed her ability to manage.

Since all eating disorders involve food, we also strive to help sufferers reconnect to their bodies and normalized eating patterns. We want them to understand the positive role food plays in health, enjoyment and functioning, as well as learn to honor satiety and hunger cues. Ultimately, we hope they will accept and value the natural, God-given size and shape of their own bodies.

For any clinician who values such approaches to eating disorder treatment, Vyvanse is an inappropriate medication choice for those who suffer from BED. A drug such as this serves to disconnect a woman from her body by shutting off hunger cues, which will result in weight loss.

Unfortunately, the trauma associated with a rape, the rejection she experienced from her mother, the spiritual chasm that developed because God seemingly let her down when she needed Him most—whatever emotional turmoil she has been living with is still there. It does not miraculously disappear with appetite suppression or weight loss.

Treating an obese person who struggles with BED with Vyvanse is not much different than considering weight restoration from tube feeding for a person with anorexia. A weight-related goal will be achieved. However, once the medication is curtailed, or the feeding tube is removed, the eating disorder will return. Or, she will substitute it with another equally harmful coping technique, such as chemical addiction or self-harm.

She will do this because she remains a wounded and hurting individual—a woman still in need of healing.

Those who promote market or prescribe Vyvanse to treat BED without highlighting the aforementioned risks are doing the public, and especially those with BED, an extreme disservice. For some, the return is at best temporary, and in the worst scenario, deadly.

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