From the annals of Wait, Really???, doctors can now prescribe Vyvanse for Binge Eating Disorder. They can’t (officially) prescribe it for weight loss (and Shire, the drug company that makes Vyvanse, definitely can’t advertise it for weight loss) but not surprisingly, a substantial number of people with Binge-Eating Disorder are seriously overweight.
Vyvanse was brought to market as a medication for attention-deficit disorder, and like many ADD drugs, it’s an amphetamine. Yep. Good ol’ speed. From the 1940s until the 1970s, amphetamines were routinely handed out as diet pills. “Stay fit and Slim By taking Amphetamine,” suggests an ad from 1940. Dexedrine would make you slim and give you the energy to do housework, if you were a 1950s housewife. Obetrol was a blend of amphetamine salts and marketed straight up as a diet pill.
In the late 1960s, there were some high-profile deaths from diet pill abuse, and concern about amphetamines addiction spiked. Most of the amphetamines being used illegally were not being cooked in an Albuquerque camper at that point. Instead, they’d been made by the drug companies — a New York Times article from 1970 quotes an official from the National Institutes of Mental Health saying that about 8 billion tablets per year were being manufactured, and the FDA estimated that at least half were diverted from actual medical purposes. Also, whether amphetamines actually did anything long-term for weight loss was in doubt.
In the 1970s, amphetamine-based diet pills were banned. First warning labels were added, and the FDA began to pressure doctors reduce the amount of amphetamine they were prescribing. In 1972, sharp quotas were placed on the drug companies, restricting how much amphetamine they could make.1 In 1973, the FDA recalled injectable amphetamines, and in 1979, they banned amphetamines for weight loss purposes entirely. They remained legal as medications for narcolepsy and ADD. And, in fact, Dexedrine is still prescribed for ADD and narcolepsy. Obetrol was withdrawn from the market but re-introduced in the 1990s as Adderall. Richwood, the original manufacturer of Orbetrol and then Adderall, was even bought out by Shire, the company that makes Vyvanse…though they sold the rights to Adderall a few years later, and now it’s made by someone else.
So. Vyvanse. I’m not going to make fun of Binge Eating Disorder, although when the educational website (owned by Vyvanse, though Vyvanse is never mentioned) tells me on every other page that this is a “real medical condition,” I find that kind of the opposite of persuasive. Personal accounts like this one are much more compelling.
Vyvanse was approved for treatment of Binge Eating Disorder because they did a randomized, double-blind, placebo-controlled study on adults with moderate to severe Binge Eating Disorder (all participants were binging at least 3 times per week for at least 2 weeks prior to the baseline). Vyvanse reduced the mean number of binge days from 4.79 to 0.78, compared with 4.60 to 2.22 with the placebo. That’s a legit and statistically significant finding, and actually raises some very interesting questions about what, exactly, is going on with eating disorders, anyway, and why Vyvanse would help.
Vyvanse is used, mostly without controversy, to treat ADD. The current prevailing theory is that ADD involves something going wonky with some of your neurotransmitters, impairing executive function — “executive function” being what allows you to resist the temptation to eat the marshmallow…
…and stimulant medications make those bits work better.
The success of Vyvanse in treating specifically the compulsion to binge makes me wonder if binge eating disorder is a disorder of executive function, and that’s why ADD medication makes it easier for people who take it to resist the impulse to binge. Or, does it work because the bingeing is often triggered by hunger, and amphetamines make you less hungry?2
Fundamentally, it’s hard to shake the sense that what Shire is doing is shady. For starters, there’s the way they append “a real medical condition” to every mention of Binge Eating Disorder. Their helpful educational website offers tips on how to doctor-shop: “If you still feel your concerns weren’t addressed, don’t give up. Health care providers are accustomed to being asked for referrals. Don’t be afraid to ask for a referral to a doctor or other health care professional who specializes in eating disorders.” They’ve hired a celebrity spokesperson — a slender, attractive one. They tell you over and over that it’s not for treating obesity, but it’s not like the diet pill history of amphetamines is some sort of closely guarded industry secret. They know. You know. I know. Your doctor knows.
Should you take this pill?
Well, if you actually have binge eating disorder, by all means see an eating-disorders specialist! If you’re doing something self-destructive with food, that’s a real medical condition, and eating disorders specialists are the people who treat it. If they think Vyvanse will help you? Give it a try. Millions of people out there are being helped, right now, by drugs with shady marketing campaigns. I may be irritated by the marketing, but that doesn’t mean I’m opposed to better living through chemistry for you or anyone else.
But that website is objectively shady, for sure.
I was surprised not to find more pushback on this from the drug companies. A 1972 New York Times article, “Crackdown on a Drug That Maims And Kills,” commented on this: “Surprisingly, there has been almost no reaction to the Government proposals from the drug industry. Individual manufacturers say that they will go along or that they have no comment. The Pharmaceutical Manufacturers Association is saying nothing about the quota even though it would deny the association’s members millions of dollars in sales.” Apparently for various reasons the pharmaceutical industry felt beleaguered enough in the early 1970s that amphetamine diet pills were not a hill they were going to die on. ↩