Lisdexamfetamine (Vyvanse) for Binge Eating Disorder (BED): How It Works and What to Expect
Binge Eating Disorder (BED) is the most common eating disorder in the United States, affecting an estimated 3.5% of adult women, 2% of adult men, and 1.6% of adolescents (Hudson et al., 2007). It is characterized by episodes of eating large quantities of food in a short period of time, often accompanied by feelings of distress, guilt, and a lack of control.
While therapy and nutritional support are essential components of BED treatment, Lisdexamfetamine dimesylate (Vyvanse) is the first and only FDA-approved medication for moderate to severe BED in adults. It is not approved for use in bulimia nervosa or in pediatric BED, but for the appropriate patient, it may be a valuable part of a comprehensive treatment plan.
This post explores how Vyvanse works, its potential benefits and risks, and what to expect if it’s prescribed for BED.
What Is Lisdexamfetamine (Vyvanse)?
Vyvanse is a central nervous system (CNS) stimulant that was originally developed to treat Attention-Deficit/Hyperactivity Disorder (ADHD). It is a prodrug of dextroamphetamine, meaning it is inactive until metabolized by the body, which helps reduce potential for misuse.
In 2015, Vyvanse became the first medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of moderate to severe Binge Eating Disorder in adults.
How Does Vyvanse Work for BED?
The exact mechanism isn’t fully understood, but it’s believed that Vyvanse acts on dopamine and norepinephrine pathways, which play a role in impulse control, reward processing, and attention.
In BED, these neurotransmitter pathways may be dysregulated, contributing to:
Loss of control during binge episodes
Compulsive eating behavior
Cravings for high-reward foods
Mood instability and distress post-binge
Vyvanse may help by:
Reducing binge frequency and severity
Decreasing food-related obsessions or preoccupations
Enhancing self-regulation and impulse control
Potentially reducing co-occurring symptoms of ADHD, if present
What the Research Says
A series of randomized, double-blind, placebo-controlled trials have supported Vyvanse’s effectiveness:
Primary Efficacy Results (McElroy et al., 2015):
Vyvanse significantly reduced the number of binge days per week compared to placebo.
Participants experienced greater global clinical improvement and reduced obsessive thoughts about food.
Additional Benefits:
Some individuals experienced modest weight loss—though this is not the primary goal in BED treatment.
Improvements in functioning and distress related to eating were noted.
Limitations:
Not all patients respond
Effects are dose-dependent, with higher doses (50–70 mg/day) more effective than 30 mg/day
Benefits are sustained only with continued use
Who Is Vyvanse Appropriate For?
Vyvanse is typically considered for adults with moderate to severe BED who:
Experience frequent binge episodes (e.g., ≥1–3 days/week)
Have distress and impairment related to bingeing
Have not responded adequately to therapy alone
May also have ADHD, which could be treated simultaneously
It is not appropriate for individuals who:
Have a history of substance use disorder
Have active cardiovascular disease, uncontrolled hypertension, or arrhythmia
Are underweight or engaging in restrictive eating or purging
Are under the age of 18 for BED treatment (not FDA approved in this group)
What to Expect When Starting Vyvanse
💊 Dosage and Administration
Typically started at 30 mg/day
May be increased gradually to 50 mg or 70 mg/day, depending on response and tolerance
Taken once daily in the morning (taking it later can cause insomnia)
⏳ Timeline
Some people notice reduced binge urges within 1–2 weeks
Full effects may take 3–4 weeks
Medication should be taken consistently for best results
Potential Side Effects
Common:
Dry mouth
Insomnia
Decreased appetite
Increased heart rate or blood pressure
Anxiety or irritability
Headache
Rare but Serious:
Cardiovascular events (especially in those with preexisting conditions)
Psychiatric effects (e.g., mania, psychosis in susceptible individuals)
Dependency or misuse (particularly in those with substance use history)
Patients should be monitored regularly for:
Blood pressure and pulse
Sleep patterns
Mood changes
Effectiveness in reducing binge behaviors
Medication Is Not a Standalone Treatment
While Vyvanse can reduce binge frequency, it does not address the emotional, cognitive, or relational factors underlying BED. For best results, it should be used alongside:
Cognitive Behavioral Therapy (CBT)
Nutritional counseling with a registered dietitian
Body image and self-compassion work
Treatment for trauma, anxiety, or depression, if present
Final Thoughts
Vyvanse is a valuable tool in the treatment of moderate to severe binge eating disorder—but it’s not a magic bullet. It works best as part of a comprehensive, compassionate recovery plan that honors the whole person, not just the behavior.
If you or a loved one is struggling with BED, speak with a qualified healthcare provider about whether Vyvanse might be an appropriate addition to your treatment path—and make sure it’s accompanied by the psychological and nutritional support necessary for long-term healing.
References
McElroy, S. L., Hudson, J. I., Mitchell, J. E., et al. (2015). Efficacy and safety of lisdexamfetamine for treatment of adults with moderate to severe binge-eating disorder: A randomized clinical trial. JAMA Psychiatry, 72(3), 235–246.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
Citrome, L. (2015). Lisdexamfetamine for binge eating disorder in adults: A systematic review of the efficacy and safety profile. Neuropsychiatric Disease and Treatment, 11, 1741–1749.
FDA. (2015). Vyvanse prescribing information. U.S. Food and Drug Administration.
Hudson, J. I., et al. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348–358.
