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Heroin Addiction and Related Clinical Problems: 2025, 27, 31

The use of Bupropion/Naltrexone in a small sample of female bipolar disorder patients with bulimia nervosa

Manuel Glauco Carbone, Luca Mazzetto, Rossella Miccichè, Alessandro Bellini, Roberta Rizzato, Giulia Gastaldello, Claudia Tagliarini, Filippo Della Rocca, and Angelo Giovanni Icro Maremmani

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-31

Summary: Background: Bipolar disorder (BD) and eating disorders (EDs) often coexist, creating complex symptoms with emotional dysregulation, reward hypersensitivity, and impaired control. Up to one-third of BD individuals show binge eating, but evidence for pharmacological treatment of BD–bulimia nervosa (BN) is limited. The naltrexone/bupropion combo, approved for obesity, targets hypothalamic pathways and reward circuits, potentially helping with binge eating. Methods: We reviewed seven adult women with BD and BN treated with naltrexone/bupropion in routine care. All were euthymic, on stable lithium, BMI < 25 at start. Data at baseline, 1, and 3 months included binge episodes, compensatory behaviors, food craving (FCQ-S), affective lability (ALS), emotion dysregulation (DERS), and trait craving (FCQ-T). Changes were tested with Friedman tests, effect sizes with Kendall’s W and Cohen’s d. Results: Binge episodes decreased significantly (p = 0.029; W = 0.508), shifting to lower categories by 3 months. FCQ-S scores dropped notably (d = 1.82), especially in “intense desire to eat” (p = 0.008; d = 2.05) and “anticipation of relief” (p = 0.027; d = 1.77). Compensatory behaviors trended downward but were not significant. Craving was linked to emotional dysregulation, especially DERS Clarity, Non-Acceptance, Impulsivity, and between affective lability (ALS Anger, Depression/Elation) and trait craving. Conclusions: Early findings indicate naltrexone/bupropion may lessen binge-eating severity and cravings in women with BD–BN, possibly via modulation of satiety, reward, and prefrontal control. These results support an integrated neurobiological approach and need confirmation in larger, longer-term studies.

Keywords: Bipolar disorder; Bulimia nervosa; Naltrexone/bupropion; Food craving; Emotional dysregulation.