Psychotherapy-Supported Lisdexamfetamine Tapering in Binge-Eating Disorder: Spotlighting a Critical Research Gap

This spotlight highlights a critical gap in the research literature. Despite evidence that combined cognitive-behavioral therapy (CBT) and lisdexamfetamine dimesylate (LDX) for binge-eating disorder (BED) is superior to either intervention alone, no studies have examined whether psychotherapy can support gradual tapering off LDX while preserving treatment gains. While evidence shows higher rates of binge-eating relapse after LDX discontinuation, long-term use is complicated by concerns regarding side effects (e.g., hypertension), misuse-potential, cost, and/or drug interactions. Unfortunately, without current research on optimal LDX tapering strategies, clinicians lack guidance at a critical juncture.

Given the absence of studies that have examined tapering psychiatric medications in BED, let alone any established protocols for doing so, the authors offer two spotlighted examples to illustrate the potential utility and clinical challenges of therapist guided LDX discontinuation during psychotherapy for BED.

The spotlighted examples demonstrate that binge relapse can be avoided through gradual LDX tapering embedded within psychotherapy, with treatment gains sustained at long-term follow-up (up to 5 years after LDX discontinuation).

This spotlight highlights the need for further research to investigate discontinuing LDX and whether gradual, therapist-supported tapering might enable the superiority of combined treatment to be sustained. Spotlighted examples were used to illustrate the conceptual framework and clinical relevance of this spotlight's central argument: that systematically evaluating optimal approaches to medication discontinuation, specifically LDX for BED, is an idea worth researching. We describe potential obstacles and limitations while also highlighting clinical or policy implications for future study.