Treating Night Eating Syndrome with Sertraline

People with the night eating syndrome eat large amounts of food in the evening, awaken during the night to eat again, and have little or no appetite in the morning. Their mood is usually low and worsens as the day goes on. Night eating has many health implications because it is associated with psychological distress and obesity.

John P. O’Reardon, MD and colleagues at the University of Pennsylvania recently reported that sertraline, a selective serotonin uptake reuptake inhibitor (SSRI), was effective for treating night eating syndrome and was well tolerated in a small study. Thirty-four outpatients diagnosed with night eating syndrome were randomly assigned to receive either sertraline or placebo during an 8-week double-blind study with a flexible-dosage (50 to 200 mg/day) design (Am J Psychiatry 2006; 163:893). The study also measured changes in night eating symptoms, the number of nightly awakenings, and ingestions, total daily caloric intake after the evening meal, Clinical Global Impression (CGI) improvement ratings, quality of life, and weight.

Dramatic Results Appeared after 2 Weeks

On the CGI improvement rating scale, 12 of the 17 subjects who received sertraline responded; 7 of the 12 had remission or complete resolution of night eating symptoms. In the placebo group, only 3 responded, and only 1 of the 3 had remission of symptoms. The greatest reduction of symptoms occurred between baseline and week 2; according to the authors, overall, a subject receiving sertraline had a 30% chance of responding by week 2. Changes in night eating symptoms were also significantly greater among the sertraline group, and by week 8, the night eating symptom scores of the sertraline group had dropped by 18.1 points (57%) from baseline, compared with a reduction in symptoms of 5 points (16%) among those in the placebo group. There was also a significant reduction in the frequency of nocturnal eating episodes among the sertraline group compared to the placebo group. The number of nocturnal ingestions in the sertraline group fell by 81%, versus a fall of 14% for the placebo group.

Caloric Intake, Weight Change, and Quality of Life.

Caloric intake after the evening meal fell by 68% in the sertraline group, from 47.3% of total daily calories at baseline to 14.8% at week 8. In the placebo group, in contrast, caloric intake after the evening meal fell by 29.3%, from 44.7% at baseline to 31.6% at week 8. Overweight subjects (14 in each group) in the sertraline group lost 2.9 kg versus 0.3 kg in the placebo group, a significant difference.

Effects

Sertraline was well tolerated, and no one withdrew from the study due to adverse effects. One person in each group dropped out because of lack of effect. Common side effects were mild and included dry mouth, fatigue, diminished libido and sweating.

The SSRI had an early and dramatic effect on the 14 night-eaters who received it. Even though the subjects had night eating symptoms for an average of 17.6 years before entering the study, 4 of the 5 fast responders achieved full remission after only 2 weeks of 50 mg of sertraline a day. The authors noted that in an earlier study a significant reduction in binge eating and vomiting was reported in a group of patients with bulimia nervosa after a single week of treatment with the SSRI fluoxetine (Br J Psychiatry 1995;166:660). They suggested that the nocturnal eating, while not actually binge eating, share the psychological component of disinhibition with the eating binges of bulimia, and that serotonergic medications such as fluoxetine and sertraline have the potential to quickly ease the feeling of control present in both disorders.