Section - Quick Takes

05. Naltrexone–Bupropion and Behavior Therapy, Alone and Combined, for Binge-Eating Disorder: Randomized Double-Blind Placebo-Controlled Trial

Published on February 1, 2023 Certification expiration date: February 1, 2026

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

A basic behavioral therapy plus a placebo was associated with higher remission rates than naltrexone–bupropion combination alone.
However, that same therapy plus the medication combination was associated with a higher remission rate than therapy plus placebo.
The dosages used can be approximated using generic pills, with data from a 2009 study as a guide.

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Should psychiatrists consider treating obesity? Whoa! Big time scope of practice concerns there. Imagine the criticisms. On the other hand, we do treat eating disorders, which include binge eating, which is closely related to obesity, and a combination of medications we routinely use—bupropion and naltrexone—has shown substantial weight loss effects. So, let’s take a look at a new randomized trial of that medication combination in a study of binge-eating disorder by a team that is also deeply interested in psychotherapy for eating problems.

Hi! Jim Phelps here for the Psychopharmacology Institute. There are 4 arms in this study, various combinations of medication and psychotherapy and placebo. Let’s start with the psychotherapy. It’s a behavioral treatment that focuses on making gradual behavioral lifestyle changes—moderate decreases in calories targeting 1500 kilocalories per day; improved nutrition quality, meaning less than 30% fat; and what they call moderate increases in physical activity, a target

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Learning Objectives:

Examine evidence in favor of and against the use of N-acetylcysteine in treatment-resistant schizophrenia.
Compare outcomes of ketamine and ECT in the short-term treatment of major depressive disorder.
Examine 5 mechanisms by which acute COVID-19 infection might lead to long-term neuropsychiatric sequelae.
Examine the results of a randomized trial for sublingual dexmedetomidine for the treatment of acute agitation in patients with a diagnosis of schizophrenia or schizoaffective disorder.
Compare the efficacy of a basic behavioral therapy and naltrexone–bupropion combination for the treatment of binge-eating disorder.

Original Release Date: February 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: February 1, 2026

Expert: James Phelps, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

James R Phelps declares the following interests:

- McGraw-Hill: Royalties

- W.W. Norton & Co.: Royalties

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

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Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.