Lamotrigine use in patients with binge eating and purging, significant affect dysregulation, and poor impulse control

ABSTRACT Objective Some patients with symptoms of binge eating and purging are successfully treated with specific serotonin reuptake inhibitors (SSRIs), but others experience only partial or no benefit. Significant affect dysregulation and poor impulse control may be characteristics that limit responsiveness. Method We report on the treatment of five patients with bulimia nervosa (BN), anorexia nervosa—binge/purge type (AN‐B/P) or eating disorder not otherwise specified (EDNOS), using the anticonvulsant lamotrigine after inadequate response to SSRIs. Results Following addition of lamotrigine to an antidepressant in four cases, and switch from an antidepressant to lamotrigine in one case, patients experienced substantial improvement in mood reactivity and instability, impulsive drives and behaviors, and eating‐disordered symptoms. Discussion These findings raise the possibility that lamotrigine, either as monotherapy or as an augmenting agent to antidepressants, may be useful in patients who binge eat and purge, and have significant affect dysregulation with poor impulse control. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:329–334)