Secondary outcomes and qualitative findings of an open-label feasibility trial of lisdexamfetamine dimesylate for adults with bulimia nervosa
Abstract Background There is emerging evidence that stimulants warrant further investigation as a treatment for bulimia nervosa (BN) including a recent open-label feasibility trial examining the use of lisdexamfetamine dimestylate (LDX) for BN. The current report presents the secondary outcomes and...
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Journal of Eating Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40337-023-00796-x |
| _version_ | 1827725161941434368 |
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| author | Laura Dixon Sara Bartel Victoria Brown Sarrah I. Ali Susan Gamberg Andrea Murphy Katherine L. Brewer Susan L. McElroy Allan Kaplan Abraham Nunes Aaron R. Keshen |
| author_facet | Laura Dixon Sara Bartel Victoria Brown Sarrah I. Ali Susan Gamberg Andrea Murphy Katherine L. Brewer Susan L. McElroy Allan Kaplan Abraham Nunes Aaron R. Keshen |
| author_sort | Laura Dixon |
| collection | DOAJ |
| description | Abstract Background There is emerging evidence that stimulants warrant further investigation as a treatment for bulimia nervosa (BN) including a recent open-label feasibility trial examining the use of lisdexamfetamine dimestylate (LDX) for BN. The current report presents the secondary outcomes and qualitative interview results from that feasibility trial. These outcomes explore several purported mechanisms that may explain how stimulants affect symptoms of BN: appetite, impulsivity, obsessive and compulsive symptoms, eating disorder psychopathology/impairment and reward-based decision-making. Methods Twenty-three participants with BN received LDX for eight weeks. Questionnaires assessing appetite, impulsivity, obsessive and compulsive symptoms, eating disorder psychopathology and impairment were administered at baseline and post-treatment. Participants also completed a two-step reinforcement learning task to assess their decision-making. Semi-structured interviews took place at baseline, week 5, and follow-up. Results Reductions in hunger, food-related impulsivity, obsessive and compulsive features, eating disorder psychopathology and impairment were found. However, reward learning, as far as it is assessed by the task, did not seem to contribute to the effect of LDX on BN symptoms. Qualitative analysis suggested four themes: (1) reprieve from the eating disorder, (2) improvement in function and quality of life, (3) renewed hope for recovery, and (4) ability to normalize eating. Conclusions This report suggests several potential mechanisms by which LDX may reduce symptoms of binging and purging in those with BN. Importantly, due to the open-label design, we are unable to attribute findings to the medication. Instead, our results should be interpreted as hypothesis generating to inform future studies such as adequately powered randomized controlled trials. Trial registration NCT03397446. |
| first_indexed | 2024-03-10T22:25:33Z |
| format | Article |
| id | doaj.art-d9c364e85ad749729270c6217f1448c9 |
| institution | Directory Open Access Journal |
| issn | 2050-2974 |
| language | English |
| last_indexed | 2024-03-10T22:25:33Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Eating Disorders |
| spelling | doaj.art-d9c364e85ad749729270c6217f1448c92023-11-19T12:07:50ZengBMCJournal of Eating Disorders2050-29742023-05-0111111010.1186/s40337-023-00796-xSecondary outcomes and qualitative findings of an open-label feasibility trial of lisdexamfetamine dimesylate for adults with bulimia nervosaLaura Dixon0Sara Bartel1Victoria Brown2Sarrah I. Ali3Susan Gamberg4Andrea Murphy5Katherine L. Brewer6Susan L. McElroy7Allan Kaplan8Abraham Nunes9Aaron R. Keshen10Eating Disorder Program, Nova Scotia Health AuthorityEating Disorder Program, Nova Scotia Health AuthorityEating Disorder Program, Nova Scotia Health AuthorityEating Disorder Program, Nova Scotia Health AuthorityEating Disorder Program, Nova Scotia Health AuthorityDepartment of Psychiatry, Dalhousie UniversityCollege of Doctoral Studies, University of PhoenixLindner Center of HOPEDepartment of Psychiatry, Centre for Addiction and Mental Health, Institute of Medical Science, University of TorontoDepartment of Psychiatry, Dalhousie UniversityEating Disorder Program, Nova Scotia Health AuthorityAbstract Background There is emerging evidence that stimulants warrant further investigation as a treatment for bulimia nervosa (BN) including a recent open-label feasibility trial examining the use of lisdexamfetamine dimestylate (LDX) for BN. The current report presents the secondary outcomes and qualitative interview results from that feasibility trial. These outcomes explore several purported mechanisms that may explain how stimulants affect symptoms of BN: appetite, impulsivity, obsessive and compulsive symptoms, eating disorder psychopathology/impairment and reward-based decision-making. Methods Twenty-three participants with BN received LDX for eight weeks. Questionnaires assessing appetite, impulsivity, obsessive and compulsive symptoms, eating disorder psychopathology and impairment were administered at baseline and post-treatment. Participants also completed a two-step reinforcement learning task to assess their decision-making. Semi-structured interviews took place at baseline, week 5, and follow-up. Results Reductions in hunger, food-related impulsivity, obsessive and compulsive features, eating disorder psychopathology and impairment were found. However, reward learning, as far as it is assessed by the task, did not seem to contribute to the effect of LDX on BN symptoms. Qualitative analysis suggested four themes: (1) reprieve from the eating disorder, (2) improvement in function and quality of life, (3) renewed hope for recovery, and (4) ability to normalize eating. Conclusions This report suggests several potential mechanisms by which LDX may reduce symptoms of binging and purging in those with BN. Importantly, due to the open-label design, we are unable to attribute findings to the medication. Instead, our results should be interpreted as hypothesis generating to inform future studies such as adequately powered randomized controlled trials. Trial registration NCT03397446.https://doi.org/10.1186/s40337-023-00796-xBulimia nervosaLisdexamfetamine dimesylateQualitative researchStimulantPharmacotherapy |
| spellingShingle | Laura Dixon Sara Bartel Victoria Brown Sarrah I. Ali Susan Gamberg Andrea Murphy Katherine L. Brewer Susan L. McElroy Allan Kaplan Abraham Nunes Aaron R. Keshen Secondary outcomes and qualitative findings of an open-label feasibility trial of lisdexamfetamine dimesylate for adults with bulimia nervosa Journal of Eating Disorders Bulimia nervosa Lisdexamfetamine dimesylate Qualitative research Stimulant Pharmacotherapy |
| title | Secondary outcomes and qualitative findings of an open-label feasibility trial of lisdexamfetamine dimesylate for adults with bulimia nervosa |
| title_full | Secondary outcomes and qualitative findings of an open-label feasibility trial of lisdexamfetamine dimesylate for adults with bulimia nervosa |
| title_fullStr | Secondary outcomes and qualitative findings of an open-label feasibility trial of lisdexamfetamine dimesylate for adults with bulimia nervosa |
| title_full_unstemmed | Secondary outcomes and qualitative findings of an open-label feasibility trial of lisdexamfetamine dimesylate for adults with bulimia nervosa |
| title_short | Secondary outcomes and qualitative findings of an open-label feasibility trial of lisdexamfetamine dimesylate for adults with bulimia nervosa |
| title_sort | secondary outcomes and qualitative findings of an open label feasibility trial of lisdexamfetamine dimesylate for adults with bulimia nervosa |
| topic | Bulimia nervosa Lisdexamfetamine dimesylate Qualitative research Stimulant Pharmacotherapy |
| url | https://doi.org/10.1186/s40337-023-00796-x |
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